Standing Committee E

[Mr. Eric Illsley in the Chair]

Health Bill

Amendment proposed [this day]: No. 29, in clause 35, page 32, line 47, at end insert— 
'( ) Regulations under subsection (2) must make provision for all those with entitlement to GOS to retain the right to have that delivered by the provider of his or her choice.'.—[Dr. Murrison.] 
Question again proposed, That the amendment be made.

Eric Illsley: I remind the Committee that with this we are taking the following amendments: No. 30, in clause 35, page 32, line 47, at end insert—
'( ) Regulations under subsection (2) must make provision as to the right of those qualifying for a GOS sight test to have that sight test, and for the provider to be recompensed without any limitation on the number of sight tests carried out either in total or at any listed practice.'. 
No. 31, in clause 35, page 32, line 47, at end insert— 
'( ) Regulations under subsection (2) shall direct that the Primary Care Trust will not be able to place any limitation on the number of providers or performers listed in their area, or deny the right of any performer listed by another Primary Care Trust to undertake sight tests in their area.'.

Andrew Murrison: Your arrival was impeccably timed, Mr. Illsley. We now reach our final sitting, and I do not know about anybody else, but I am certainly exhausted, notwithstanding the Christmas break. However, we still have many clauses to plough our way through. There is plenty of stuff to get stuck into and plenty to entertain us for the next three hours or so.
We have discussed clause 35 at some length, and it is important that we have done so, because it deals with the significant issue of choice in ophthalmic services. As we said, we are most concerned about the choice element in the seven clauses that deal with primary ophthalmic services. Choice is what we have on the high street now, and our concern is that the Bill will impinge on the choice that our constituents have across this particular spectrum. The Minister probably got the impression that I am very much a fan of ophthalmic services as they are currently configured, and I hope that she did, because I am. That part of what I might broadly define as our health services is well worth emulating, and that is nowhere more true than on the crucial issue of choice and people's ability to go wherever they want. 
So far, the Minister has offered a pretty good, robust defence of the Bill and particularly of why it is necessary to introduce the seven clauses. If I am correct, the reasons centre on enhancing the opportunity to provide services and on a concern to address fraud within ophthalmic services. We have discussed fraud to some extent and have asked her to compare and contrast the cost of the administration that PCTs will undoubtedly have to shoulder as a result of these seven clauses with the estimated  £10 million of fraud that she is rightly attempting to eschew from the system—I am not sure where that estimate comes from, but it does not sound unreasonable, given the turnover that we are discussing. It is important that we contrast those figures, because it emerged in our deliberations this morning that counter-fraud is one of the cornerstones on which these seven clauses are based. Even at this stage, I hope that she can give us a greater insight into how, or indeed whether, she has compared the money that she hopes to save by removing fraud from this element of health service transactions with the cost that the clauses will undoubtedly involve—the undefined cost that PCTs will apparently have to bear. That will be translated into employing more people to carry the business forward, to do the contracts and the rest of it. 
Towards the end of this morning's deliberations, as we were getting into the debate on the amendments—this is the after-dinner part of it—we discussed whether it might be appropriate to have a national contract and national arrangements at least for the sight test. Earlier today, we managed to tease out the difference between the sight test fee and moneys that might arise as a result of the provision of primary ophthalmic services. I am grateful to the Minister for clarifying what we mean by those two things, because they seem to be different in that one is not cash-limited. It is a centrally identifiable sum of money, although it is handled by PCTs, but it is not cash-limited, and that is quite important. That becomes interesting in the context of the basing of the contracts. We can foresee a situation in which a practice exhausts its contractual obligations for any given year and then, as I said earlier, has to sit on its hands for the rest of the year. 
Although it is not their principal aim, our amendments would address that situation, because they would ensure that people could choose which practitioner they went to. That cuts both ways: it would also ensure that people were not sitting on their hands for a whole month at the end of the financial year once their practice had discharged its obligations and they had no more work. We have not really heard much from the Minister on that. It has a parallel with the dental contract in one respect, and that is the margin. Last year, in relation to the dental charging regulation, we debated the margin of error that the dentists will be allowed in relation to their contracts. It is rather tight. Just a small divergence from the contract would result in a penalty. The professions will be interested to know what penalties—

Nadine Dorries: On dental comparisons, many dentists have chosen not to provide NHS services. In my area, one cannot find a dentist who will treat NHS patients. If that situation were allowed to develop and optometrists and opticians found themselves running out of budget and unable to treat patients, having waiting lists, and experiencing difficulty negotiating with PCTs, they, too, might decide to withhold their services and become solely private providers. Then they would not have any contract with the PCT and would  operate, much as dentists do, as wholly private opticians.
We would then find the situation in relation to optical services the same as the one in relation to dental services. Somebody who needs an eye test but cannot afford one might not be able to have it because the opticians will have opted out of the system.

Andrew Murrison: My hon. Friend makes an interesting point. At the moment, there is no incentive for that to happen, because the fee is remarkably low for a variety of reasons. One of them is the cross-subsidy between the provision of specs and the NHS test. In fact, one of the beauties of the way in which the system has evolved is that there is no real market. There is a sight test that is well respected; people know what they are going to get when they go for a test and they are content to have it. I cannot imagine that people going to see an ophthalmic practitioner in the high street really differentiate between NHS and non-NHS in the way that they most certainly now do in dentistry. To that extent, the two are not directly comparable, but I understand what my hon. Friend means.
Again, I emphasise that ophthalmic services seem to be a model to be emulated by other parts of the service. They have evolved in a way that—I sound like a salesman for the sector, which I do not mean to be—offers value for money and is incredibly accessible. No other part of our health service is quite as accessible as this one. The Minister will no doubt say that there are walk-in centres, and one can always go to an accident and emergency department to get immediate treatment, but that is not the same as obtaining primary ophthalmic services on the high street. One would have to go to continental Europe to find anything remotely similar in the provision of health services, broadly defined. 
That is why we are very cautious about anything that will fundamentally change that element of health care. In that, we appear to be joined by the profession, going by the briefing notes to which the Minister referred earlier. Her reading of them is slightly different from mine, but it appears clear that the profession is very concerned about these changes. We also know that from the evidence of our constituency mailbags. In nearly five years of being an MP, I have not had one complaint about primary ophthalmic services, and we know that complaints about such services form a tiny proportion—a fraction of 1 per cent.—of all complaints received by family health services committees. That is set against the very large number of consultations that are going on year in, year out. 
The lack of complaints is our assurance of quality and backs up our position. The Minister did a fine job this morning defending these seven clauses, but she will forgive me if I say that Opposition Members have the imperative on this issue and we are backed in that by the profession and by the statistics and figures, which support our contention that this is a high-quality service, providing what people want. We should not be trying to affect it or to change it fundamentally. We should be trying to emulate it elsewhere in the health service. 
Amendment No. 32 was, sadly, not selected, for reasons that I have discussed. However, I am not sure whether I am permitted to mention it in the clause stand part debate. If I may just describe it in general terms—

Eric Illsley: Order. The amendment has been ruled out of order and not selected. If the hon. Gentleman wants to raise the issues that he intended to raise in relation to that amendment, he will have to wait for a clause stand part debate.

Andrew Murrison: Thank you for that clarification, Mr. Illsley. I will raise the amendment as part of the clause stand part debate and I am grateful for your willingness to hear comments on it in that debate, because it is quite important.
May I deal with what I am enjoined to discuss: the three amendments in this group? I hope even now that the Minister may be able to smile favourably on the amendments, which relate entirely to choice. I hope that she will reconsider her remarks about audit and inspection, because she seemed to be quite dismissive of the cost that may be involved, through the PCT, in overseeing her arrangements to do with the contract. It seems counterintuitive to suppose that, if someone enters into a contractual arrangement with a provider, they will not have any obligation to check the arrangement more thoroughly than if they simply have somebody on a list. 
I think that we deal with the list in a little more depth later in the Bill and I would be grateful to know what it means in terms of primary care trusts. We maintain that such a list would perhaps be better held centrally, by which we mean nationally. That might be a way of getting around some of the expense that I identified earlier. With that, all that I need to do at this juncture is to withdraw amendment No. 29 and look forward to the clause stand part debate, which I am sure will be exhaustive. I beg to ask leave to withdraw the amendment. 
Amendment, by leave, withdrawn. 
 Question proposed, That the clause stand part of the Bill. 
Several hon. Members rose—

Andrew Murrison: We are all leaping to our feet. We now come to the bit that I thought we were at. My apologies, Mr. Illsley: my lunch was obviously rather better than I planned and I got ahead of myself in my enthusiasm to get to amendment No. 32. You will recall that that amendment was ruled out of order for technical reasons that are slightly lost on me because I do not have the abilities of the parliamentary draftsmen available to the Minister, or the paraphernalia that supports her performance in this Committee. Essentially, the amendment would insert the following:
''Regulations under section 16CD(4) shall direct that the remuneration paid to providers for each sight test shall be a nationally negotiated fee as agreed from time to time by the Secretary of State.''
The Minister might say, ''Well, that is funny, because the Conservatives are keen on deciding things locally.'' Indeed, there is cross-party consensus that we should,  where possible, negotiate things locally. That is right and proper, and it is nice that we should have such consensus, but it might seem a little odd that we should insist on a national fee. 
It seemed to me, although I am not entirely sure, that the Minister suggested in her remarks earlier today that, de facto, that is what will happen. I hope so, for a raft of reasons, which we have dealt with to some extent, such as that such a system would get around the problem of different fees being negotiated in different primary care trusts. The Minister said that it was her intention that that should not happen, but admitted that it might. She is vastly more experienced than I am, but it seems to me that it would be strange to rely on her assurance in this Committee that there is a theoretical possibility that a particular outcome might happen, but that it is not her intention that it should. That is unacceptable. We must close such loopholes. That is why we spend hours and days going through the Bill bit by bit, clause by clause, and comma by comma. 
In the light of the Minister's earlier remarks, I should have thought that she welcomed the amendment, which you, Mr. Illsley, disallowed for technical reasons. Nevertheless, I recommend to her the burden of what it says. I am sure that she and her parliamentary draftsmen colleagues could craft a form of words that got around that apparent technical difficulty and ensure that the figure is negotiated centrally and will apply to all PCTs, thus getting away from the possibility of competitive advantage and disadvantage applying from one place to another. It would prevent guileful people such as me from getting tests more cheaply in one part of the country and going to another part for their specs, and would prevent the big providers from acting in a similar perverse fashion. I am sure that it is not the Minister's intention that such situations should arise. More particularly, for the public service, it would mean a saving for PCTs. This morning, we rehearsed the argument, which I do not want to go over again too much, that PCTs are overburdened with administrative cost and bureaucracy. They have the dental contract coming in a few weeks. It will be interesting to see what happens with that. The National Audit Office is rather concerned about PCTs' capacities for managing those contracts, and here is another one on which they have to negotiate—potentially on individual terms. 
Before I withdraw the amendment that was not selected and which I did not move, if I may make that tautology, will the Minister give some assurance that she hears what I say, that it is categorically not her intention that the fee should be different from one PCT to another and that she will, in some way that she can describe, make sure that that illogicality is not built into the Bill? It seems to us that a central contract administered through the Business Services Authority might be a more appropriate and cheaper way of doing things. It would certainly be a lot more cost-effective in terms of PCTs and in the context of trying to save money. The Minister admitted that she wants to save  money on fraud. We need to find savings where we can. We must not, in the course of that, burden organisations with more bureaucracy and cost, thereby diluting any efficiency savings that might be achieved. I am sure that we are all singing from the same hymn sheet on this issue, and I commend our general thinking to the Minister. 
There are a few technical points relating to the clause that it was not appropriate to deal with through amendments, but I hope that the Minister will expand on them. Proposed new section 28WB contains no reference to qualifications or registration levels for practitioners, which seems a bit strange. Clause 36, which we will come to shortly, deals with the issue in a little more depth but is really not that specific. This morning, we talked about entering into contracts with various people and the Minister talked about expanding the opportunity for various organisations to provide services. It is important to know about the qualifications and registration of those operating the services, and to know what the Minister is expecting to see. 
Across the whole range of medical health services we rely on qualifications and registration, yet these seven clauses seem to be fairly qualification-light. We have not talked much about the differences between the various practitioners, except to get tongue-tied over some of them. It would be interesting to know why the Minister has not felt it necessary to stipulate the qualifications of the various persons who may be involved with the contracts. As far as I recollect, that stands in contrast to the Government's changes in relation to pharmacies. I recall spending a considerable time talking about qualifications in that context. Some comment on that from the Minister would be most welcome. 
Proposed new section 28WC refers to the disqualification of persons from entering into a GOS contract, but it does not really tell us much about the grounds for those disqualifications. Are they professional? Are they to do with probity, which the Minister mentioned earlier; with negligence, although the incidence of complaints is very low, so I suspect that that issue would not come up often; or with contractual disputes? If the latter, that is when the provision potentially becomes a little more sinister, because applications for disqualification could be based on organisations that are perceived as being a little difficult. For example, a high street single-handed practitioner might be regarded as more difficult to work with than Specsavers. We seek reassurance about what the Minister means with regard to disqualification, and what the grounds might be for disqualification. 
We know that there is an appeals mechanism through a committee set up by the Secretary of State for Health, and that is right and proper, but such a committee would, of course, involve considerable outlay by the appellant, and would mean time, effort, anxiety, uncertainty, and potentially lost trade. It is important to understand the grounds for disqualification, so perhaps a little detail from the Minister might be appropriate. 
We have not talked at great length about the cost of the contract. That is strange, because in general when we discuss legislation we are used to having a regulatory impact assessment that goes into that subject in some detail. The Minister has assured us that she does not think that the new arrangements will involve a great cost. The more I think about it, the more I think the costs will be considerable. We are breaking down the contract into a myriad little bits that will have to be individually negotiated and worked through by primary care trusts. It will be new for the PCTs, which will have to set up new structures as a result. That will take manpower time. We all know what happens in such circumstances. Before anyone is appointed, the position has to be advertised. The PCT—the trust in my area is quite small—will suddenly have to take on additional staff to deal with ophthalmic services. That will represent a significant increase in the overheads that PCTs will be expected to shoulder. 
Blithely to say that the proposals will be cost-neutral—that it will be a zero cost venture—is somewhat disingenuous. Considerable costs will be involved, and it is appropriate to set them against the £12 million identified as fraudulent, especially as the Minister gave that as the cornerstone for these seven clauses, and one of two reasons identified this morning. If it is so very important to save that £12 million, we need to consider setting it against the costs resulting from the implementation of chapter 2. My ''back of a cigarette packet'' calculations—if I may use such a phrase, given our earlier deliberations—suggest that the cost of the provisions might start to approach that sum. A more reflective assessment by the Minister of the cost of implementing the GOS contract through the continuing myriad of PCTs would be appreciated. 
I am grateful, Mr. Illsley, for your indulgence in allowing me to expound at length on the clause. It deals with a number of important issues and I look forward to the Minister's assurances on the points that I have raised.

Nadine Dorries: During the break, I had to go to Boots to buy another pair of glasses, because my old ones were not working. The new ones are not working terribly well, either. Frankly, I think I am better off without them. I shall try my best.
Clause 35 empowers the Secretary of State to rewrite the contract between the NHS and ophthalmic practitioners for the provision of general ophthalmic services. It opens up the real possibility of a PCT refusing to enter into a contract with an optometrist, or to vary the contract in such a way as to exclude those optometrists who the PCT feels are not needed. Nothing in the Bill would prevent that from happening. 
The Minister has failed to assure us that any qualified optometrist or optician who meets the necessary criteria and who has the appropriate qualifications will be able to provide ophthalmic services on the high street for all those in the local community who wish to use their services. I am concerned about the responsibility of PCTs for commissioning general ophthalmic services. My PCT  is running a £20 million deficit. In order to recover that deficit, it is restricting emergency services, which is almost a complete contradiction. 
Given those deficits, one cannot help but put oneself in the shoes of a PCT chief executive and wonder how the trust would cope with the additional responsibilities of handling the GOS contract. In the face of increasing demand for ophthalmic services in the community, I doubt whether the PCT would honour the contractual rights of every optometrist and optician. The very nature of the Bill means that, at some time, cash will be limited, and that will enable the PCT to decide to whom it wants to award a contract. I know that the Minister gave some verbal reassurances this morning, but the wording of the Bill will not prevent that from happening. 
Taking that one step further, were we a PCT we would try to get the best value for the budget that we were awarded because, if we limited the number of providers the flow of people would be restricted and we would have to start a waiting list. The PCT would not want to have to deal with the possibility of waiting lists for eye care services, so it could be tempted to negotiate the best deal possible with the bigger providers. We could even see the bigger players strategically planning new development and future growth based on such PCT-negotiated deals. I again ask the Minister to give the categorical reassurance that the eligible population will retain access to NHS sight tests at the practice of their choosing in their community—not at the choosing of the PCT, but still that of the patient. 
A PCT could make such a choice because it felt that from an administrative point of view handling the process of a small number of claims from a small number of outlets would be easier and far cheaper, and that could be presented to the PCT as an advance in clinical governance and therefore become a quality issue. As we discussed this morning, and I think agreed, patient choice is the driver of quality. 
The PCT could decide to put the general ophthalmic service contract out to competitive tender in order to save money and to acquire less volume. Every PCT we know is cash-strapped, almost all are running a deficit and it is easy to see how PCTs could choose to ignore or reprioritise patient choice in the face of financial pressure. After all, they have to take much tougher measures with arguably more vital services. As I said, my PCT is restricting emergency services. The prospect of having to restrict ophthalmic services would be a walk in the park; it would not even break into a sweat faced with that option. It would be easy for a PCT to decide that there were sufficient practitioners in a particular town or high street and that they simply did not need to award contracts to any more. We have not heard anything in Committee today from the Minister that would prevent that from happening. In fact, there is nothing in the language of the Bill to prevent such a scenario. 
Were a large provider to be commissioned by a PCT, a similar fate could affect our opticians as has affected post offices or high street pharmacies. As we know, the people who feel the effects of closing post offices and high street pharmacies are the elderly, those  in rural locations, the house-bound or those of restricted means. High street optometrists are of significant importance to those groups of people, as are post offices and high street pharmacists. 
Optometrists and opticians are not a group of people that one would normally describe as radical or political. They are well behaved caring professionals, carrying out a vital role. However, as my mother-in-law frequently used to say, even a worm can turn. If the budget became cash-limited, if PCTs restricted budgets to optometrists, if not every optometrist and optician could obtain a contract, as they have a right to do now, one could foresee, as I described in my earlier intervention, their finding a way to withdraw their services, as dentists have done. Then, very much like dentists, people would see optometrists and opticians as a political punch-bag, as politically motivated or affected. 
At the end of this debate we need to hear from the Minister a guarantee that every practising optometrist, ophthalmologist and optician will be able to practise in future; that they will have a right to the contract, as they have at the moment and have always had; that the budget will not be cash-limited; and that anybody in the community will have access to services, as they have now.

Andrew Lansley: I want to ask a couple of questions under clause 35, which I do not think we have quite touched on.
Under the general ophthalmic services contract, the primary care trust will be able to contract with providers to provide not only the sight test but other services. There is a relationship between those, in so far as many practitioners offer a range of additional examinations attendant upon a sight test. Dependent upon who is doing the sight test, it varies from a minimum examination to something that is looking for pathology. 
My first question is about the extent to which the Government are expecting to specify what the sight test is, using the powers in clause 35. To what extent are they open to looking again in the current consultation at the sight test and, with the Scottish example of an eye examination in mind, at whether it would be appropriate for it to tend more toward pathology, rather than being concerned simply with examining the qualities of somebody's sight? 
Secondly, on the structure of payments, what are the Government expecting? If we look at these changes and those for GPs and dentists, the nature of the contracts has varied. All these contracts are concerned to varying degrees with quality, volume and cost. Concerning GPs, they have essentially been about quality and volume. With dentists, they have substantially been about volume. With ophthalmic services, there is a risk that they could be substantially about cost. What is the Government's intention in that respect? How far are they expecting to extend payment by results and the tariff into the determination of contracts for ophthalmic services? To the extent that  the Government propose that, it diminishes the opportunity for primary care trusts to negotiate contracts by reference to costs. Can we have some idea about that, or are we simply legislating with no idea of what the regulations will be?

Steve Webb: I want to give the Minister a brief opportunity to place on the record certain assurances regarding the ophthalmic services covered by this clause, which I understand have been given by the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton), who is not with us today. Those assurances were about what the contracts cover, and they are headed in a briefing which Committee members may have seen from the Association of British Dispensing Opticians, the Association of Optometrists and the Federation of Ophthalmic and Dispensing Opticians.
I am sure that the Minister is familiar with the meeting that took place between her colleague and that group on 27 October, subsequent to which a letter was written on 8 November by a Mr. Derek Busby, Ophthalmic Services, Department of Health. Sometimes, where assurances are given by officials to professional bodies on behalf of the Government, it is worth ensuring that they are placed on the official record, so that they have greater weight, as it were. The gist of it was that, under clause 35, the new general ophthalmic services contracts will cover three things; essential, additional and enhanced services. 
To ensure that my understanding, and indeed that of the professional bodies, is correct, can the Minister confirm, first, that there are essential services that all PCTs—and anyone holding a GOS contract—have to provide? The example given was of sight tests for eligible NHS patients. Secondly, can she confirm that there will be additional services that all PCTs, but not all contractors will have to provide? The PCT must ensure that someone is providing those services, but not all contractors will have to do so. Thirdly, might there be enhanced services? The professional bodies are recommending that those should, again, be covered within the contractual framework. Particular PCTs might judge that those are needed in their area. 
Mr. Busby says, of what I have just described, 
''This provides a framework for future service development . . . building on the success of the current GOS system . . . ensuring that PCTs have a duty to make sight tests available to meet the needs of their eligible populations on a similar basis to the GOS now''.
I would be grateful if the Minister confirmed that the assurances given to the professional bodies are also her understanding. To quote from one further sentence by Mr. Busby, 
''the Bill enables the Secretary of State to define''—
those things that I have just talked about, but it then says: 
''(in substance, although these terms are not in the Bill)''.
One is always wary when an official writes to a professional body, saying ''This is what the Bill means, but we don't use those words in the Bill.'' 
Can the Minister clarify whether these are informal equivalents of what is actually in the Bill, or are there  reasons why that language was not used in the Bill and it was not felt necessary to specify that there? Clearly, the professional bodies have been reassured by that letter. I hope that the Minister can reiterate those reassurances and clarify how those things arose.

Caroline Flint: I will try to deal with those points, but in some respects I shall repeat points that I made earlier on the purpose of the clauses. Nothing in the clauses is seeking to undermine some of the good ways in which the service is currently delivered.
I have to say to the hon. Members for Westbury (Dr. Murrison) and for Mid-Bedfordshire (Mrs. Dorries)—he is a doctor and she is a nurse—that there has been a lack of understanding, in some of their contributions, of the present arrangements by which those providing services locally have to engage with PCTs. 
It is important that the present sight testing system is maintained, but we are trying, through widening the opportunity for PCTs to contract with people, to get around an anomaly that currently exists, whereby dispensing opticians and lay members cannot directly contract for services and take a roundabout route by which a qualified optometrist has to be the link person whom they are employing for the contract. We are trying to make a more open, transparent system in that regard. 
The following points may cover a number of the points that were made. We envisage the sight testing service operating exactly like the general ophthalmic service that is currently in use. On patients being able to choose their GOS contractor, there is no way that we are trying to limit the opportunities for individuals to have a sight test under proper conditions wherever they want. 
The point was made about contractors being able to have a GOS contract, provided that they meet agreed national criteria. That will be subject, as now—I emphasise as now—to local decisions on matters such as quality of service, including inspection of equipment and premises. Clearly, that is more easily done locally, and it is done less bureaucratically by not necessarily having a national body to inspect the premises and equipment to ensure that they are up to standard. 
We will also, as I have said repeatedly, continue to have a centrally negotiated sight test fee and access to sight tests will not be constrained locally by individual PCT budgets. I have said that several times, but it does not seem to have been picked up by the hon. Member for Mid-Bedfordshire.

Andrew Murrison: Will the Minister give way?

Caroline Flint: No, the hon. Gentleman made a number of points and I should like an opportunity to answer.
Comments have been made about the level of the fee. National negotiations take place on that matter year in, year out, but there is no way that the centrally provided, nationally negotiated fee for sight tests is connected to local provision by PCTs. The clauses ensure that there is a duty on PCTs regarding sight test provision in their local communities—not on a  residence basis, enabling someone to go out of their residential area to have a sight test, but on a catchment basis. 
Whatever the PCT wishes to do to enhance services or to provide other services—I have given a number of examples of what those services might be—it in no way depends on any link to the fees and reimbursement for the sight tests prescribed in legislation and in regulations and guidelines about who will carry them out and what standard of qualification they should have. I hope that that is clear. 
The reality is that at the moment there is no right, per se, for anyone to have the contract—that provision does not exist—so there is clearly some misunderstanding, despite the conversations that Committee members have had with their opticians locally. There is no right, per se, for someone to have a contract to deliver NHS services. On the other hand, there is no right per se, unless the people concerned do not meet standards, for PCTs to deny the contract. That has been explained many times in Committee and I cannot understand why some members of the Committee cannot understand it. 
It is important that we deal with the way in which services are to be provided; questions were raised in the previous debate. As to disqualification, regulations, on which we shall consult fully, will set out how that will work. It is likely that possible reasons could be history of fraud and a demonstrated unsuitability to provide a service, such as the use of unqualified staff. There would also be the possibility of an appeal to the Family Health Services Appeal Authority, which is a permanent, quasi-judicial body, with wide experience in the field, to guard against inappropriate application. That should serve as a brake on any PCT in the unlikely event of an attempt to disqualify someone who did not deserve the penalty. As I have said, there will be full discussion of and consultation on that matter before regulations are developed. 
As to costs, a regulatory impact assessment is being prepared. There has not been a detailed assessment of costs for the Bill, partly because much of the detail will be in regulations, but, in many respects, the Bill reconfirms the practices that already exist at local level, albeit allowing dispensing opticians and lay members to act directly in the contracting of services. People who currently cannot appear on the contractor list may do so in future, because it will be possible for them to discuss the contracting of services directly, instead of in the roundabout way that has been happening. 
I read out the exact figure for optical voucher fraud: about £10 million a year. That relates to patient fraud, not fraud by contractors or opticians. There are, I understand, no figures currently available for the amount of contractor fraud. However, the clauses relating to optical voucher fraud relate to contractor fraud, not patient fraud, and are therefore not directly linked to the £10 million a year. I mentioned earlier that the section or department that considers fraud issues is currently reviewing patient fraud and what more could be done to reduce the figure of £10 million. It has dropped by £3 million since a few years before  2001, but clearly we should like it to be reduced even further.

Andrew Murrison: Earlier, the Minister made the important point that the seven clauses are largely based on the need to tackle fraud, and she cited the figure of £10 million. Is she now saying that that relates to voucher fraud and would she therefore agree that the seven clauses are unlikely to affect the £10 million? We are now dealing with a sum of money—presumably several million pounds—that we have little handle on. Having identified the fraud and put a figure of £10 million on it, the Minister is now saying that it was not the fraud she was thinking of, but some other kind. I am even more confused than I was.

Caroline Flint: When at the start of our debate I talked about the £10 million of fraud, based on the latest figures, I did refer to patient fraud, because I read it from one of my briefing notes. We also had a discussion about the lists, and the hon. Gentleman spoke, too, about whether a limit would be set on the number of sight tests that could be given. What I said, if I recollect correctly, was that no floor or ceiling has been put on the number of tests that can take place—we will not say that once a certain community has reached 3,000 tests, that will be it. However, if a PCT were suspicious that the number of tests an individual contractor claimed for did not sit with the number of qualified staff able to do those tests—if, basically, the number of tests and the hours available suggested a lack of quality and possibly fraud, because tests were not carried out to a proper standard—it should be able to consider that. If there was some confusion in Committee when the hon. Member for Westbury linked that to the figures I raised earlier, I apologise if I was inadvertently responsible.
If we look back at Hansard I think that we will see that the discussion was about the hon. Gentleman's point on setting any upper limit on the number of tests and why it would be necessary for a PCT to question the number of tests carried out by an individual contractor. It was at that point I gave an example of how somebody could carry out more tests than appropriate for the number of qualified staff, which would link to a concern about the quality of those tests. I hope that I have clarified that matter. 
Without discussing amendment No. 32, which was not selected, the principal point that has been made about the NHS sight test fee is whether it should be in the Bill. We do not think that that is necessary, because it is not in present legislation. Everybody is agreed that it is so far, so good, and its not being in legislation has not led to concern about its existence. Hon. Members have said that it is important that Ministers make things clear in Committee and give reassurances. We feel that the fee will continue to be negotiated nationally. It will have a separate budget from anything provided to PCTs and in that sense there will be no change. For that and other reasons it is not necessary to have such a provision in the Bill. It has not been in such legislation before. 
To be absolutely clear on the meat of discussions on the clause, at present all clinicians who carry out NHS sight tests are listed with a PCT and all contractors must be listed with each PCT where they provide the service. As now, contractors will be able to have an NHS contract provided that they meet national criteria subject to local decisions on matters such as quality of service and the inspection of premises and equipment. National standards will be inspected locally before a provider can go on the list to have a GOS contract. There could be questions about whether a national contract would ensure quality assurance, because we would have to think about who would carry out that necessary local inspection. I hope that that makes it clear that we are not suggesting a huge leap from where we are now. The debate has allowed us to explore how much more clear and transparent the arrangements should be. A number of members of the Committee are clearly on a learning curve in that respect. 
The hon. Member for Westbury raised the question of the payment of the fees and mentioned the NHS Business Services Authority. The Business Services Authority has an established work programme and, clearly, any additions need to be carefully considered. As part of a general discussion we are talking about whether claims for optical payments should be processed by the Business Services Authority, but it would not be appropriate to specify such activity before reaching a conclusion. We are considering the issues alongside our review of which other services could be provided in the community outside of hospitals, closer to where people live. 
In drafting the proposal we followed the model provided by medical and dental legislation in relation to essential, additional and enhanced services; the terms appear in regulations but not in primary legislation. We have a duty nationally in what we pay for and provide centrally, which has been the subject of much debate today. The clauses provide the opportunity for PCTs to consider other services that they think are appropriate for the communities that they serve, and it is important that is recognised in the Bill. Alongside that there are discussions on the White Paper on services outside hospital and our review, with the profession and others, of the opportunities and potential for other services to be provided locally, which PCTs might wish to contract. 
During the break between our sittings, the hon. Member for South Cambridgeshire (Mr. Lansley) asked me whether a large contractor with a chain of contracts around the country could suggest to PCTs that he would provide other services without any change in the fee. The hon. Gentleman asked whether the PCT would look kindly on that contractor, rather than adding other contractors who could provide on-site services to the list. I hope that reflects the scenario that the hon. Gentleman put to me. My advice is that we would not endorse such a tactic and we would seek to ensure that regulations would prevent that from happening. I was told that it could be illegal, but the hon. Gentleman should not quote me on that; the lawyers will have to look at it. We would not want a  large organisation to enter into such an arrangement, which would cause difficulties. 
There is no major national chemist or fast-food chain in my mining constituency, or even a major supermarket or bookshop, as hon. Members will see for themselves if they come to Don Valley. Community pharmacies and local stores are very important in such constituencies, as my hon. Friend the Member for Barnsley, East and Mexborough (Jeff Ennis) recognises. Many services are amply provided for in some constituencies but in others they do not exist. Therefore, smaller stores and community services are vital, whether or not the health services are involved. 
I hope that I have covered most of the points raised, including those mentioned by the hon. Member for South Cambridgeshire. I understand that the sight test will, as now, be provided under the Sight Testing (Examination and Prescription) (No. 2) Regulations 1989. The hon. Gentleman asked whether that could be extended beyond the sight test itself. The powers of the new primary ophthalmic services are to provide services beyond sight tests but there will continue to be an ongoing discussion about the delivery of primary health care and the range of services that can be offered at any one time and—I shall be honest with the Committee—the amount of services that the public purse can afford to provide in a complete package. These discussions will be ongoing in the same way as in 1999 when we decided to extend the free sight test to those over 60, which was removed under the previous Conservative Administration.

Andrew Murrison: I am particularly pleased to intervene, because it seems that the Minister was about to make a political point, and we would not want that, would we? As a matter of interest, do the sight test regulations include the need to screen for, say, glaucoma? Perhaps I should know the answer, but I do not. This is important, because most opticians carry out such a test as a matter of course, and I suspect that the Minister, who has referred to the sight test regulations, will know whether the regulations in fact include that need.

Caroline Flint: I do not think that they do, but I am happy to write to the Committee on exactly what the sight test regulations cover, if that would be helpful. I think that that is all.

Andrew Lansley: Tariff?

Caroline Flint: On the tariff point, I do not know whether payment by results would apply to these services, but some issues are totally separate. The dental contract, for example, is totally different from the payment by results service. My hon. Friend the Minister of State, Department of Health, has been very forward-looking in getting dentists away from the old system of payment simply for drill and fill rather than considering people's real dental health needs. That will contribute hugely to preventing unnecessary drilling and filling, and will give dentists more of an opportunity to provide a full service. I will write to the hon. Gentleman about that if there are any issues that connect those two areas.
Question put and agreed to. 
Clause 35 ordered to stand part of the Bill.

Clause 36 - Persons performing primary ophthalmic services

Question proposed, That the clause stand part of the Bill.

Andrew Murrison: The clause should not detain us for too long. I know that I have said that before, but I really mean it this time.
I am very grateful for the Minister's lengthy exposition of the list held by the PCTs. She said that members of the Committee needed to be educated about the list, and I am very grateful for her attempts to do so. I believe, however, that we are really talking about two lists—I refer to the lists suggested in new subsection (2A). 
Lists are obviously important to the clause. The first is a list of practitioners who are qualified, and the second is a list of contractors. Given the importance that the Minister places on lists, it would be useful if she outlined what she means by a list, how one becomes a member of that list, and whether there are indeed two lists, one of which is of contractors who may not be qualified to provide ophthalmic services in the way that I understand the Minister to mean, and the other of which is of persons who are qualified to provide those services as dispensing opticians, as ophthalmic medical practitioners and so on. That is important, because we have spent some time discussing how one might become a member of that list and how one might be disqualified from it, and we need to know which list we are dealing with. 
In that context, it would also be useful to have the Minister's clarification of what is driving all this, as she seems to be concerned about the current level of opportunity for dispensing opticians and what she calls lay members to provide those services. Apart from the fraud issue, which we discussed earlier, much of this part of the legislation appears to be driven by the need to enhance the opportunity for the category of people who are lay members or dispensing opticians. 
In the context of our discussion on the possibility of opening up the provision of enhanced and additional services to a range of providers, it seems that the Minister is exercised about potential providers that do not have someone who is currently qualified to provide primary ophthalmic services. 
If that is the case, the Minister should say so categorically. Perhaps she should also say what representations she has received from organisations that have a lay member or a dispensing optician who may wish to apply for contracts. The whole thing has been driven by their needs rather than by those of the rest of the professions who might deliver primary ophthalmic contracts or by those of patients in particular. 
The clause makes reference to medical practitioners who might apply for inclusion in a list and to the fact that regulations may prescribe their qualifications and experience. I could find no reference to regulations  that may prescribe the qualifications and experience of dispensing opticians and optometrists; none of that is laid out in the clause or elsewhere in the Bill. 
That is strange and I wonder why ophthalmic medical practitioners, which I would understand to mean doctors who are qualified in ophthalmology and who are qualified to carry out primary ophthalmic services, are singled out to have their experience and qualifications defined whereas other professionals in the field are not. I am not making a judgment about whether that is a good or bad thing; I am merely intrigued to know why a difference is being established between those two groups: the ophthalmic medical practitioner, who is essentially a doctor who is additionally qualified, and dispensing opticians, optometrists and so on. It would be interesting to hear the Minister's rationale for that. I am sure that there is a good explanation in addition to her comments about the list.

Caroline Flint: As I said earlier, at present PCTs can contract with providers for NHS sight tests only if they are optometrists, ophthalmic medical practitioners or corporate bodies registered with the General Optical Council.
On the hon. Gentleman's other point, currently there are cases where dispensing opticians employ a qualified optometrist or someone else who is suitably qualified, and PCTs have to contract with individual clinicians. Lay people are in exactly the same situation. All we are doing is making sense of a situation that is already occurring. I gave examples earlier: a qualified optometrist might often provide services at a number of different business service providers. There are issues in relation to the roving person and the contract. 
Clause 36 is entitled ''Persons performing primary ophthalmic services''. It aims to ensure that, as occurs in relation to medicine and dentistry, only practitioners on PCT performers lists will be able to undertake sight tests under NHS arrangements. That is because it is important that those who are performing the ophthalmic, clinical service meet the necessary clinical standards and that only professionals who are registered with the appropriate regulatory body and are otherwise fit and appropriate persons can undertake sight testing under NHS arrangements. It is important that that is clear and that we ensure that the regulations, on which there will be full consultation, are clear about it as well. 
I come now to the qualifications that will be prescribed for practitioners on the performers list. As now, sight-test practitioners must be registered with either the General Optical Council or the General Medical Council. In the latter case, they must also meet prescribed requirements on qualifications and experience. The qualifications required to carry out either additional or enhanced services will be set out in regulations when the services are determined. The General Optical Council already has powers to establish specialists lists of practitioners who have an interest in a particular area and who have undertaken the necessary additional training, and we anticipate  that those lists will provide the basis for the standards required. 
The qualifications required of clinicians providing primary ophthalmic services other than the sight test will also be set out in regulations. PCTs must ensure that they contract with people who will be employing appropriately qualified professionals. The General Optical Council has powers, as I said, to establish specialists lists of optometrists or dispensing opticians who have undertaken additional training in particular areas, and we anticipate that optometrists and dispensing opticians undertaking additional or enhanced services would be drawn from the practitioners on those lists. 
The clause is about those persons who perform clinical services, and ensuring through regulations and discussions with the appropriate councils and professional bodies that there is rigour in the system to protect public safety and the interests of patients. I hope that deals with the hon. Gentleman's points.

Andrew Murrison: I am interested in how the list will cope with locums. Optometrists often do locums. A requirement for them to be on the list will build into the system an inflexibility that may make it difficult to employ locums.

Caroline Flint: I am not sure why that would be the case. For example, once an individual is on the performers list of one of the PCTs in Doncaster, they could practise in any part of England. They are not limited in that respect. All things being equal, this one step covers the whole picture. A situation in which a clinical professional had to sign up on every performers list around the country would be ridiculous.
The difference between the performers list and the contractors list is that the contractors have to contract with each PCT area that they cover. In some cases, PCTs work across two PCT areas—that is a separate issue. However, once a clinical professional is on a performers list—whether with the hon. Gentleman's PCT, with your PCT, Mr. Illsley, or with my PCT—they would be eligible to perform services anywhere in England. I hope that that reassures the hon. Gentleman.

Andrew Murrison: Indeed it does, but another issue occurs to me in connection with the Minister's elegant explanation of the situation. Can the Minister assure me that a person's disqualification will be articulated throughout the whole of the PCT network, as an optometrist who is disqualified by one PCT could seek to get on the list of some other PCT?

Caroline Flint: I hope that that will be the case. There would not be much point in disqualifying someone if they could turn up somewhere else and be able to practise. One would hope that there would be checks and balances in the system such that part of someone's working in an area would involve a reference to the PCT with which they are listed. I cannot explain the detail of how that will happen, but as it is an important point, I will write to the hon. Gentleman about the safeguards that would apply in such a situation. 
Another issue is that of disqualification, which, clearly, is a serious matter. In terms of choice and so on, the PCT would also be mindful of the impact on the provider of a service—and, therefore, of provision of the service—if one of its clinical professionals were disqualified. That is another reason why close relationships with the local contractor are important to deal with what I hope will be the relatively rare occasions when that may happen. 
My additional information is that there is provision for the Family Health Services Appeals Authority to disqualify a practitioner throughout England and Wales. Presumably, it has mechanisms for communicating a disqualification, and obviously we want to be reassured that, as far as is practicable, it is adhered to. I hope that members will accept the clause. 
Question put and agreed to. 
Clause 36 ordered to stand part of the Bill.

Clause 37 - Assistance and support

Question proposed, That the clause stand part of the Bill.

Stephen Williams: The clause makes primary ophthalmic services alongside primary medical and dental services eligible for the assistance and support that is available under the National Health Service Act 1977. During our deliberations, we have heard several references to the NHS in the high street. Optometrists provide important services—not only basic eye tests but screening for various conditions.
The hon. Member for South Cambridgeshire asked the Minister whether, as part of the eye tests, optometrists should look for such conditions as glaucoma. I think she said that either it was not the case or that she would check. When I met optometrists and other professionals in my constituency, I understood that as part of their professional standards they would at least look for such conditions. Whether it forms part of their contract, I do not know. However, the point is that they do it, and it sends patients on a journey throughout other parts of the national health service to obtain the relevant treatment. 
I experienced that journey some time ago when, as part of a routine eye test, the optometrist examining my eyes said that at the back of my eye I had a dark patch that needed to be checked because it could have been something serious. However, she could not refer me directly to the Bristol eye hospital's centre of excellence in my constituency. I had to see my GP and repeat what the optometrist had told me, as my GP did not examine me, although he was able to press the relevant button on his computer and send me down the road to the eye hospital. That procedure is rather strange. It is a shame that in the Government's promised review of the general ophthalmic services contracts, they could not consider such matters. Perhaps they will as part of the consultation. 
The Government could take some easy steps to bring the ophthalmic services provided on the high  street further into the NHS family of operations. We tabled an amendment—amendment No. 120—to help the Minister, but it was not selected for consideration, so I shall refer to it in general. One way of bringing optometrist services into the NHS family would be to put them on NHSOnline.net, other electronic patient record systems, or on the GP referral system to which I have referred. Provided that the patient gave informed consent, it would help the optometrist to track their patient's progress on their journey through the NHS and enable the eye profession to monitor, for instance, how glaucoma was being treated. 
The second part of the amendment referred to payments, suggesting that rather than their being made to and collected by the primary care trust, they should have been collected by the NHS Business Services Authority. I heard the Minister say in her remarks on clause 35 stand part that the Government were thinking about it. However, I should be interested to hear from her whether they have considered bringing optometrist services more closely into the family of NHS services, and particularly IT services, so that optometrists could monitor their patients throughout the different stages of the health service.

Andrew Murrison: The hon. Gentleman has made several interesting points. I am not too clear about how relevant they are to the clause; nevertheless, they were well made. He is absolutely correct about referral by GPs to optometrists and optometrists to specialists. On the back of his comments, does the Minister feel that the seven clauses before us will make the process easier? Were it to be made easier, as it is in Scotland without the intervention of such clauses, we would be doing our constituents a great favour because it would make life a lot easier for them. We would be using the ophthalmic professions a lot better, with a consequent increase in job satisfaction for them in feeling that their services, skills and expertise were being adequately utilised. Also, probably equally important, we would save the system a great deal of resources.
I gave the example of my experience of having to take my daughter to casualty in Salisbury to have a foreign body removed. That is the kind of thing that I would probably expect that enhanced services might cover. It would have been far more convenient for me to nip down to Warminster and have the thing removed on the high street, as I am sure would have been possible. We have not really heard from the Minister how she feels that the seven clauses will assist people such as me and my daughter in the removal of a foreign body on a Saturday morning. 
What do we mean by assistance and support? I do not understand what that means. I confess to the Minister that I have not ploughed through section 28Y of the 1977 Act. Perhaps I should have done so and if I had perhaps I would not need to ask the question, but as I have not it would be helpful if she could tell me what we mean by assistance and support in that context. It sounds like a good thing, so I am certainly not minded to oppose it, but the explanatory note simply does not make that meaning clear and it is not  clear in the Bill. Some explanation from the Minister would be most welcome.

Caroline Flint: The clause enables primary care trusts to support providers of ophthalmic services on the same footing as they are able to support doctors and dentists. That is a welcome extension to ophthalmic services' role in the family of services provided in local communities. Consistent with our policy of delegating functions to the front line, the clause gives PCTs a directly conferred function to assist and support providers of primary ophthalmic services in their area. Support and assistance could include financial support and the provision of premises on such terms as the PCT thinks fit. That might be important, particularly if the PCT were trying to encourage service providers to locate in areas where provision of the sight test is not as flexible and accessible as we might wish.
The clause will enable PCTs to increase primary ophthalmic services capacity by giving assistance to establish or extend ophthalmic practice premises to see, for example, more NHS patients if that is required. It could also be used if, for example, practices had some temporary problems, such as sickness or a period of maternity leave, that impacted on their ability to maintain a proper level of service for the patients. As I said, the clause is about creating a first-among-equals situation and putting ophthalmic services in the same category as support for doctors and dentists. In that respect, it should be welcome. 
The hon. Member for Bristol, West (Stephen Williams) asked about NHS Connecting for Health. That is important. Our policy for the national programme for information technology in the NHS has always been, and remains, that over time it will embrace all the clinical services in and around the NHS. I think that he would acknowledge—I know this from issues raised in the House—how ambitious a programme it is to connect up even just the hospitals with the doctors and so forth, and so we are doing this on a step-by-step basis. The task is enormously complex and we need to ensure that we get it right. Inevitably, the key core services—the NHS care records service, choose and book, the new national broadband network, and the electronic prescriptions service—have demanded and continue to demand the highest priority, but that does not mean that we have lost sight of where we want to get to in the future. There are lots of factors to consider, not least the compatibility of current IT systems among many different providers of ophthalmic services in an overarching NHS IT system. They have not been forgotten, but it is a matter of making sure we get it right, step by step.

Andrew Murrison: The Minister says that they are not forgotten; have they been anticipated? That is important, because we have had a variable assessment of the cost of NHS Connecting for Health—what used to be the NPfIT. I am not sure from what the Minister said whether that need, projected forward a few years, has been factored in  to the estimates of cost, which, by my recollection, vary from £6 billion over 10 years to £31 billion over 10 years.

Caroline Flint: I can only reiterate what I have said. From the start, it has always been the ambition that once systems are established and the technology is proven to work, all parts of the NHS and the clinical services provided on its behalf should be part and parcel of the same system. At this point, I cannot go into any more detail, but we are cautious to ensure that we carry out the process on a step-by-step basis, and there are a number of priorities in the NHS that we feel we have to deal with first. It is difficult to single out particular practitioner groups within an implementation programme that is developing as we speak.
The hon. Member for Bristol, West was right. I mentioned earlier that consideration is being given to the role of the Business Services Authority in processing payments, but that discussion is still ongoing and has to be weighed up against several other issues. I hope that the Committee will support the clause, as it gives a real opportunity for further engagement with ophthalmic services among the family of health services in our communities. 
Question put and agreed to. 
Clause 37 ordered to stand part of the Bill.

Clause 38 - Local Optical Committees

Andrew Murrison: I beg to move amendment No. 33, in page 34, line 26, at end insert—
'(c) dispensing opticians, to whom payments are made for meeting or contributing towards the cost incurred for the supply of optical appliances or their replacement or repair.'.

Eric Illsley: With this it will be convenient to discuss the following amendments: No. 116, in page 34, line 27, after 'every', insert 'dispensing optician or'.
No. 117, in page 34, line 30, after 'optometrist', insert 'or dispensing optician'. 
No. 118, in page 34, line 36, leave out paragraph (b).

Andrew Murrison: Amendment No. 33 would add dispensing opticians who supply or repair glasses to the list of persons who will comprise the local optical committee. We are a little bewildered as to why they should be left off, particularly as the Minister has a clear understanding—as evidenced by her previous remarks—of the difference between the various professions that work in ophthalmic services in and around the NHS. However, dispensing opticians seem to be disfranchised in this case.
One cannot draw a line between such professions because they are interdependent and interrelated. Sometimes they can be one and the same thing: individuals working for the same organisation who are mutually dependent on each other's activities. Indeed, there is a cross-subsidy between the eyesight test and the dispensing of optical appliances. To use another smoking analogy, one cannot put a cigarette paper between the two. 
It seems entirely appropriate that the dispensing optician arm should be reflected in the local optical committee. That said, I am a little in the dark about local optical committees, because the Bill is not entirely clear about what manner of beast they are or what they will do. The guidance notes are a summary to say the least. All they say is: 
''Clause 38 inserts new section 45C in the 1977 Act''
to which one is invited to refer, but if hon. Members are like me, they do not have a great deal of time to plough through the Act. The notes continue: 
''The new section relates to Local Optical Committees.''
I would have thought that that was extremely obvious. The notes are not particularly helpful. 
I hope that the Minister will be able to describe the committees in depth because they will be important bodies. More particularly, I hope that she will say why dispensing opticians should be left off the list when they are obviously so integral to the system and the various professions in this field are so interdependent.

Stephen Williams: Our amendments Nos. 116 and 117 essentially make the same points as those made by the hon. Member for Westbury and address the interdependency between optometrists and ophthalmic dispensers. I have mentioned several times the meeting that I had in my constituency with various members of the eye profession. It included optometrists and ophthalmic dispensers, and I learned for the first time the difference between the two. As a layman I had thought that they were all opticians, but I learned a lot at that meeting and I have learned a lot today, as I am sure we all have.
We discussed the key interdependence, particularly the financial one, when considering clause 34. The optometrist is the key professional clinician who carries out the initial health check on people's eyes and the ophthalmic dispenser then fits lenses and matches the prescription to the needs of patients. Clearly, one cannot exist without the other and there are many professional analogies, including in my tax profession. I am a member of the Chartered Institute of Taxation and can give taxation advice to people, but my profession would not exist without the skilled technicians—members of the Association of Taxation Technicians—who do much of the essential work in working out people's tax liability. 
The same is true in the eye profession, except perhaps that the value seems to lie with the skilled technicians—the ophthalmic dispensers. I referred earlier to the fee that optometrists receive for an eye test, which is a pathetic £18.39, but the value to their business is the sale and fitting of lenses that are provided by ophthalmic dispensers. It seems strange that when a committee is designed to discuss local services—new section 45C(4) to the 1977 Act refers to it as the ''Local Optical Committee'', not a local optometrist committee—ophthalmic dispensers are not considered eligible and fit to be members of that committee. That is a regrettable omission and should be corrected. 
Amendments Nos. 116 and 117 relate to amendment No. 33, which was tabled by the hon.  Member for Westbury, and amendment No. 118 is tagged on. It refers to new section 45C(3)(b) of the 1977 Act, which requires notification. That provision seems to be unnecessary, so will the Minister explain why it is necessary for it to be part of the Bill?

Caroline Flint: I am afraid that I cannot accept any of the amendments and I hope to explain why they are unnecessary.
Amendment No. 33 seeks to make local optical committees representative of dispensing opticians if they receive payments for the supply, repair or replacement of optical appliances. We accept that some optical businesses are not represented by their local optical committee. The Bill makes it clear that such committees must be representative of all providers with contracts to provide primary ophthalmic services. That allows the membership of the committee to draw from the full range of local expertise and experience and to improve their effectiveness as a local representative committee. The local optical committee provides a body with which PCTs may consult on primary ophthalmic services locally. There are equivalent committees for medicine, dentistry and pharmacy and the provision will provide a formalised body for consultation in those areas. 
Dispensing opticians and lay-owned businesses that have contracts as providers of primary ophthalmic services with primary care trusts will be represented by local optical committees, because they have a contract. That relates to the points that we made earlier about allowing dispensing opticians and lay members to contract directly to provide services. A specific reference is not needed to dispensing opticians as providers, as they are included in the general power. However, dispensing opticians and lay-owned businesses that do not have contracts with primary care trusts will not fall within that. 
We think it right that the local optical committee should be representative of providers who contract with the PCT and those who perform primary ophthalmic services in that area. However, the committee will be able to co-opt people who are neither providers nor performers of primary ophthalmic services if it wishes to do so. I do not believe that the arrangements that we are suggesting will restrict the range of persons and the expertise that can be brought to the body. 
Under amendment No. 116, there would be a specific reference to dispensing opticians as having a right to be represented by the local optical committee if they had a contract to provide primary ophthalmic services. We support the right of providers with general ophthalmic services contracts to be represented by the LOC. However, the Bill already provides, on page 34, line 27, for every person with a contract to provide primary ophthalmic services to be represented by that committee. That general entitlement includes dispensing opticians, so again there is no need for a specific reference. 
Amendment No. 117 would include a reference to dispensing opticians as performers of primary ophthalmic services alongside optometrists. However,  individual dispensing opticians do not perform primary ophthalmic services, which is currently only the testing of sight. Dispensing opticians are therefore not appropriate for inclusion in that way. There is no reason to include in the Bill one group that may at some future point provide a prescribed service, but not to include others. It is right that the local optical committee should be representative of providers who contract with the PCT and those who perform primary ophthalmic services in that area. The committee will be able to co-opt people who do not come into those categories if it wishes to do so. 
Amendment No. 118 would remove the requirement that performers of primary ophthalmic services who wish to be represented by a local optical committee should notify the committee of that. A number of optometrists will work for a number of different employers in the areas of different PCTs for short periods. We discussed that earlier. The amendment would make it mandatory that those people be represented by a number of different local optical committees. It is more sensible for a performer to be represented by a local optical committee where he works regularly and with which he has an ongoing relationship, rather than somewhere that he or she goes to occasionally. A requirement for the performer to notify the PCT that he wishes to be represented means that the practitioner will be able to consider where he or she would be best represented. 
For those reasons, I hope that the amendment will be withdrawn and that I have reassured hon. Members of our intent.

Andrew Murrison: I am grateful for the Minister's clarification. However, she has not said a great deal about the function of a local optical committee. That would have been useful for us to judge whether it was necessary for dispensing opticians to be represented on the body. We are left to deduce what the committee does. From the comparison that the Minister drew with medicine, dentistry and pharmacy, one can have a fairly good idea of what the committee might achieve. In that context, I can see her logic in not including dispensing opticians, although I still regret that.
I note, however, that the committee may include individuals who have entered into a contract, and the Bill will enable primary care trusts to enter into contracts with dispensing opticians and others—lay people, people who are not qualified in this area at all. To that extent, I accept the Minister's reassurance that the committee is unlikely to be an exclusive body that simply represents a small part of the range of professions engaged in primary ophthalmic services. That has to be a good thing. Probably with that in mind, and with the assurances that she has given, I beg to ask leave to withdraw the amendment. 
Amendment, by leave, withdrawn.

Caroline Flint: I beg to move amendment No. 112, in clause 38, page 35, line 10, leave out from 'determine' to end of line 22 and insert
'the amount of its administrative expenses for that year. 
( ) A Primary Care Trust may— 
(a) on the request of a committee recognised by it, allot to that committee such sums as it may determine for defraying the committee's administrative expenses; and'.

Eric Illsley: With this it will be convenient to consider Government amendment No. 113.

Caroline Flint: These two amendments seek to ensure that local optical committees are representative of both local providers and performers by providing a simpler arrangement for the committee. The only money available in general ophthalmic services are the fees paid by primary care trusts for the services for which they contract. Those fees may be paid only to contractors and are not paid direct to performers. As local optical committees are to be representative of both providers and performers of primary ophthalmic services, it seems only right that the fees paid for the provision of the services should meet the total expenses of running the committee.
Requiring performers to make a separate payment would almost certainly be a disincentive to being involved in the local optical committee, which would make it less representative and may lead to primary care trusts not recognising such committees. Therefore, a simple levy against the fees paid is in our view the right approach. It will be simply and easily administered and will help to ensure that local optical committees are representative of performers as well as providers. It continues the present arrangements for funding these committees and therefore I hope that hon. Members will support the amendments.

Andrew Murrison: This is fairly straightforward, but I should be grateful if the Minister told us the anticipated level of the levy. She has assured us that it would not be particularly high, but it would be useful to know what it might be approximately. Presumably, there are parallels with other committees to which she referred earlier.

Caroline Flint: I do not have those figures to hand, but I can assure the hon. Gentleman that we would want to see that the levy was proportionate and not over-expensive. I will write to him with further information about that.
Amendment agreed to. 
Amendment made: No. 113, in clause 38, page 35, leave out lines 27 to 32.—[Caroline Flint.] 
Question proposed, That the clause, as amended, stand part of the Bill.

Andrew Murrison: This is a largely uncontroversial clause, so I shall not detain the Committee long on it. It would be good to know what the Minister's intentions are in respect of the function of the committees. I am sure that it is necessary, and common sense suggests that it will not be hugely burdensome on the profession, or the public purse for that matter. However, it would be useful to know exactly what it will achieve.
We have remonstrated with the Minister up to this point about the lack of the review that we were promised. Undoubtedly, the fact that we have not had that review has meant that there have been several holes in this area of debate and several things left  unanswered. I suspect that the local optical committees will have a fair amount of work to do in interpreting the Bill and carrying forward its provisions. In particular, the committees may consider things such as enhanced and additional services, which we have not heard a huge amount about in the debate. It is not referred to directly in the Bill or the guidance notes that go with it, but it is referred to in the briefing documents that we received from the profession on the back of discussions that the profession had with Ministers. 
I assume that the provision of additional and enhanced services, some of which we have discussed, broadly speaking, would be the stuff of the local optical committees. They would be proactive in making recommendations to the PCT on how its members could improve the health of the PCT's patient base. It would be useful to hear the Minister's thoughts on that, as well as a little more description of exactly what she envisages local optical committees doing.

Caroline Flint: There is not much that I can add to what I said earlier, which is that the committee would mirror similar committees that are provided for other local services, in that it would form a body of people whom the PCT could consult on a range of issues. As I suggested, those issues could include cases where the PCT wants support in helping providers in different ways. That was covered by an earlier clause. The issues could be about the particular eye health needs of the community, and about sharing information about the changes happening locally with providers and performers.
As I have said, a review is ongoing, and that review addresses what secondary care could be provided in a primary care setting. I imagine that PCTs, in putting their views across to Government, may want to discuss that with others in future. I am sure that that debate will develop over time. I hope that that gives the hon. Gentleman some idea of what we are talking about, but obviously it is difficult to just pull out a list. The committees will not just receive information, I hasten to add; they will be a vehicle for their members to share their expertise, experience and knowledge with the PCT. That will ensure that the sight testing policy, which is centrally funded, and for which the PCT is reimbursed, is working properly. Also, the committees will form part of a discussion about enhanced services. 
I do not have the figures for the cost at the moment, but I expect that it will be very low. We are talking about the expenses of the committee, of hiring rooms for meetings and, my officials suggest, of tea and biscuits—we had better knock that off, because that is not very necessary. Is it healthy? Perhaps we should say a plate of fruit instead. We are not talking about a tier of administrative support. The committee is an identified body that can act as a formal sounding board that the PCT can engage in discussion, so that it feels that it has a greater understanding of what is happening in the local area in terms of health needs and other issues. I hope that that reassures the hon. Gentleman. 
Question put and agreed to. 
Clause 38, as amended, ordered to stand part of the Bill.

Clause 39 - Payments in respect of optical appliances

Stephen Williams: I beg to move amendment No. 80, in clause 39, page 36, line 7, at end insert—
'( ) A description set out under subsection (2) shall include any person unqualified to dispense optical appliances to persons under the age of 16.'.

Eric Illsley: With this it will be convenient to discuss amendment No. 119, in clause 39, page 36, line 7, at end insert
'which may include persons unqualified to dispense optical appliances to persons under the age of 16.'.

Stephen Williams: The clause is to be welcomed. We have heard several references today to the need to address fraud in the system, although there have been disputes about the extent of that fraud. The clause is a welcome step towards making sure that PCTs have added powers to put checks in place to make sure that the voucher system is not abused in any way. We have heard from the hon. Member for Mid-Bedfordshire, who has on display an array of spectacles from a variety of outlets. I am sure that they are all bona fide outlets, but I understand that the profession has concerns about unscrupulous providers who may abuse the system, particularly in relation to spectacles that may be bought over the internet.
The purpose of the amendment is to strengthen the clause slightly to make it clear that the only people who are allowed to dispense spectacles to children are optometrists, qualified ophthalmic dispensers and doctors. That builds in a further safeguard that would not only protect children's health, but make sure that the voucher system—it is frequently children who have vouchers for glasses—is not open to further abuse. That is the purpose of the amendment.

Caroline Flint: The amendments are alternatives, both of which seek to restrict to registered opticians or medical practitioners those who might receive payment for the supply, repair or replacement of optical appliances. Amendment No. 80 seeks to make it mandatory and amendment No. 119 would create a regulation-making power. I support the hon. Gentleman's general intention. We are committed to ensuring that payments for optical appliances are made appropriately when work has been carried out properly and legally. The law already requires that sales of optical appliances for children and most such sales to adults be made under the supervision of a registered optician or medical practitioner. Our view is that the supervision of sales of optical appliances by a registered dispensing optician, optometrist or medical practitioner offers adequate protection.
As we discussed earlier, businesses might be owned by people who are not members of one of those three clinical professions. So long as they employ qualified professionals to supervise sales, those sales are proper and optical vouchers may be used to make the purchases. I therefore suggest that amendments Nos. 80 and 119 be rejected. However, I understand the  concern, which has been rightly voiced, that we should reconfirm the importance of ensuring that qualified practitioners are involved in the sale of those accessories.

Stephen Williams: I have listened carefully to the Minister. She was fairly conciliatory, so I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn. 
 Question proposed, That the clause stand part of the Bill.

Caroline Flint: We intend to make it a condition of receiving payments for optical vouchers that individuals or companies make available records relating to the transaction when required to do so by a PCT. Failure to comply with that condition would be sufficient reason for a PCT to refuse to make payments, as it could give grounds for concern that the money could not be accounted for and that there was, therefore, a clear risk that public funds were being misused. That is an important aspect of ensuring that the vouchers are used in a way that is above board and that the scheme is implemented properly.
Question put and agreed to. 
Clause 39 ordered to stand part of the Bill.

Eric Illsley: There is now a long list of clauses without any amendments, so I shall announce the clause stand part and take them in a group. If any hon. Member wishes to speak to clause stand part on any of them, he should stand so that I can be aware of that, and we will take the preceding group. I hope that that is clear.
Clause 40 ordered to stand part of the Bill.

Clause 41 - Compulsory disclosure of documents for purposes of counter fraud or security management functions

Question proposed, That the clause stand part of the Bill.

Andrew Murrison: I am rather confused. We are nearly there and can tick off the minutes until 7 o'clock, draw a deep breath and go for the final furlong. There is not a great deal in chapter 3 with which we would take issue. Nobody can possibly object to the protection of any part of the service from fraud and unlawful activities. We would certainly support the Government's intention to ensure that lawfulness obtains to the NHS and that we remove fraud wherever we find it. That said, the devil is always in the detail.
When eschewing unlawful activity, there is a danger that we trample over sensitivities that are important, particularly matters to do with confidentiality. As we go through the list of clauses, I will be pressing the Minister to assure the Committee that confidentiality is maintained as a high priority, while respecting the need on occasion to divulge information to appropriate bodies. Where that happens, it needs to be done in a controlled and measured way. 
We know from various bits of the public service that when the reins are loosened, sooner or later, because of the size of the public service, we lose control to an extent over that information. That is wrong in itself, but it also gives the public the impression that the system is not copper-bottomed, not—to use another metaphor—watertight. That is to be regretted. 
We can think of the incident regarding the Driver and Vehicle Licensing Agency, reported some two or three years ago now, when a rogue individual was able to put information into the public domain and the difficulty that that caused. There have been many other episodes, fortunately mostly minor. That of course was by commission. If we loosen the reins, mistakes will be made. That is inevitable, and material will get to where it should not be, by default. That seems likely as a result of the measures because they give us less of a hold over sensitive information than we had previously. We have to make a judgment as to whether that is acceptable, given our need to ensure that what goes on in the national health service and elsewhere in the public sector is lawful, and to clamp down on fraud, which we understand to be substantial. I would like to hear from the Minister a brief exposition on the extent of the problem that she has identified and requires addressing in chapter 3. 
We have just dealt with a chapter in which we suggested that the Government had identified a problem that did not exist and had come up with seven clauses to solve that problem. I am not going to level that accusation at the Government here—broadly, clauses 41 to 52—because we are content that there is fraud within the NHS. We hope that fraud is not rampant, but we accept that there is some in the system. The Government, as a responsible one, will wish to reduce that and to ensure that we get efficiency from our service and that those who are miscreants are brought to book. We will support the Government in that, in a way that we would not necessarily support them in the clauses discussed hitherto. What is important is that we have an assessment of the scale of the problem before we consider whether the remedy proposed, in terms of disclosure, is worth the cost, to put it bluntly. 
There are a number of ways in which confidentiality in the NHS is being challenged and threatened all the time. Briefly, we mentioned Connecting for Health—what used to be called NPfIT—and the potential that that has for challenging a guarantee of patient confidentiality. I imagine that the use of Connecting for Health would be considered as part of the measures that the Minister will bring forward to combat fraud and unlawful activities within the NHS. What would be useful in the course of the discussion of the clauses is if the Minister gave us a description of how NPfIT or Connecting for Health might be used or abused in the course of such activities. 
In summary, although I broadly welcome the intention behind this set of clauses, I sound a cautionary note. I hope that the Minister will be able to tell us what the problem is and the extent of it, and how by addressing that problem we will not unacceptably damage confidentiality in respect of how sensitive patient records are dealt with.

Jane Kennedy: I hope that by having a brief debate on these issues we can answer some of the legitimate concerns that the hon. Gentleman has raised. He has rightly asked us to demonstrate why it is necessary to extend the range of criminal offences and to give major powers to officers of the Counter Fraud and Security Management Service of the NHS in order to counteract the problems that we face.
In general terms, in order to continue to counter fraud in the NHS, and to enable us to continue to take steps to make it a safer organisation to work in, authorised counter-fraud and security management specialists require relevant information to be produced when undertaking investigations. The hon. Gentleman has generously accepted that that is clearly necessary. In the most serious cases, those specialists will work with the police, who may use their powers of entry, search, seizure and arrest. However, it is not always possible to make use of police powers, because of resource issues. In any event, that is often a drain on valuable police time. The proposed powers will be exercised only by highly trained and accredited NHS counter-fraud and security management specialists. They will be able to apply all of their NHS knowledge and expertise to ensure that only material relevant to a particular investigation is obtained by them and that it is retained within the NHS. All obtaining of documents in that way will be supervised by senior officers in the service. 
Later clauses introduce specific criminal offences, such as failure to produce a document on the part of those being investigated. Because we take patient confidentiality extremely seriously, we are introducing an offence of the wrongful disclosure or misuse of information obtained in that way, so that it is clearly reinforced to those involved in the process precisely how seriously we take the role that they will play. 
Let me describe the extent and nature of the problem. In the brief period of seven years since the CFSMS was created in 1998, the NHS has benefited from an additional £675 million for better patient care, thanks to the work of that service. That highlights the fact that we face a big problem. If that funding is spent wisely, it could be used to pay for five new hospitals—perhaps not some of the private finance initiative projects that are around, but a number of smaller ones—27,000 heart transplants or 170,000 hip replacements. Let me mention some of the types of cases where this wonderful service is having a big impact. It has an annual budget of £14 million. In just one case in the last year—where it detected, intercepted and prosecuted a cartel that was operating in generic drugs—it recovered £16 million from the company involved. Therefore, in just one case it paid for the running of its own service. However, it has been operating in a number of areas. Overall losses in patient fraud have been cut as a result of the work of the service by 54 per cent. from £171 million to £78 million. That comprises an estimated fall in pharmaceutical patient fraud, which is basically prescription fraud. Dental patient fraud has fallen by 48 per cent. and optical patient fraud by 23 per cent. The hon. Gentleman and other Committee members  may be interested to learn that fraud committed by health professionals generally has also fallen. 
One reason why we probably do not make more of the work of the counter-fraud service is that we acknowledge that the vast majority of health professionals work quite properly and that the thought of committing fraud does not even come into their heads. Sadly, some health professionals do consider committing fraud, but there has been a reduction in losses caused by health professional fraud of between 43 per cent. and 54 per cent. 
Dentistry is one example of the way in which the service might change as a result of understanding how fraud has been committed and acting on suggestions. The amount of money claimed for the recalled attendance allowance has fallen from £14.3 million to £6.6 million almost overnight as a result of changing the form by which dentists made claims for that allowance. 
This is a very important area of work. I am intensely proud of the work that staff are doing, and I believe that the measures in these clauses are important in enabling them to continue and to develop that work. 
The hon. Member for Westbury expressed specific concerns about patient confidentiality. It is important to reiterate how strongly we all share his view. It is essential that any information obtained through the use of these powers is used appropriately. A new criminal offence is to be introduced in later clauses to cover the unlikely event in which information is disclosed inappropriately, thereby adding another tier of protection to ensure patient confidentiality. For example, a counter fraud and security management specialist commits an offence if they wrongly disclose information in an investigation. If they are found guilty of that offence as a result of the changes that will be made later in the Bill, they could be sentenced to a maximum of two years' imprisonment, or fined, or both. Patient record confidentiality is paramount, so inappropriately disclosing information will not be tolerated. The offence will apply to a range of people, including the person to whom the information is disclosed. 
The Bill also contains provisions for certain information in certain cases to be required under court order under the supervision of a court, and there are further provisions to enable us to work with the courts to ensure that, where information important to a fraud case is to be presented to the court but where the detail of the information, although anonymised, may lead to a patient being identified, a court may meet in private in a closed session so that evidence can be presented to it but in a way that protects the identity of the patients involved. 
I appreciate the concerns that the hon. Member for Westbury has expressed and the way in which he expressed them. He asked me how the national programme for information technology fitted in with the counter fraud work. Many safeguards are in place, but he will have to forgive me in this instance, as I will have to write to him and to other members of the  Committee after I have looked into the matter in more detail, because I simply do not have a detailed answer for him now. I will consider specific concerns, and discuss the query with my officials after our considerations today. I hope that I can reassure him about NPfIT in writing after the sitting. 
With that rather quick but, I hope, useful broad-brush explanation about why we believe that the powers are important, I hope that members of the Committee will be content to give these clauses a fair wind. 
Clause 41 ordered to stand part of the Bill. 
Clause 42 ordered to stand part of the Bill.

Clause 43 - Notice requiring production of documents

Question proposed, That the clause stand part of the Bill.

Jane Kennedy: The clause deals with the notice requiring the production of documents and, generally speaking, with disclosure. The crux of our concerns is that this and the next couple of clauses might cause a problem as regards confidentiality and the handling of sensitive data. I am particularly worried by the obligation that the clause places on NHS contractors to disclose. That obligation is important because, under this Government, health services are being used in a more catholic way and without regard necessarily being given to the boundaries between the NHS and the private sector. I welcome that because it is a good thing, but it self-evidently causes difficulties in contractual arrangements.
One difficulty is that we are introducing legislation that might require retrospection. There is currently a large number of contracts with various partners in the private sector, which lay out terms and conditions fairly clearly, and, I imagine, deal with issues such as disclosure. I also imagine that most independent sector providers regard their records as their business and would want to protect their patients' confidentiality as closely as they can—I certainly hope that that would be the case. However, the Bill places obligations on such providers, and my question to the Minister is whether those will be deemed to be retrospective. In other words, will the Bill alter the contractual arrangement that the NHS has with those who provide services in the independent sector or is it simply prospective? 
If the Bill is retrospective, that clearly introduces a range of interesting conundrums. Prospectively, it might well alter the way in which independent sector providers view the NHS. Many such providers deal with highly sensitive material on individuals and would clearly want to be absolutely sure that any information that they divulged was suitably anonymised. I would be grateful if the Minister commented on the measures that she will take to ensure that providers are given the confidence that they require to take forward contract negotiations with the NHS. However, I am particularly concerned about any possible element of retrospection.

Jane Kennedy: On retrospection, the counter fraud service already has powers to recover losses—even going back over time—where it uncovers fraud and can demonstrate that it has taken place. Where there is evidence that the contractor has abused contracts that have been agreed, the counter fraud service already has powers to recover funds from the organisation that has been defrauding the NHS. Those powers will apply to records—including those created before the legislation—that might be relevant to counter-fraud work. There would need to be clear evidence of fraud, and the vast majority of people engaging in contracts with the NHS have nothing to be concerned about in these powers. However, as I have said, there are already powers to take action. They have been used on many occasions and hundreds of thousands, if not millions, of pounds have been recovered for the NHS through being able to demonstrate that fraud had been taking place.
The new powers will apply to all those who are directly employed and, equally, to all of those contracted to provide medical services to the NHS. By that, I do not just mean the independent sector. All of those who are contracted but whom we do not normally think of as working in the private sector—GPs, for example, opticians, dentists and others—would be counted as such contractors. 
I hope that I have given the hon. Gentleman the reassurance that he sought in raising those concerns. 
Question put and agreed to. 
Clause 43 ordered to stand part of the Bill. 
Clauses 44 to 46 ordered to stand part of the Bill..

Clause 47 - Disclosure of information

Question proposed, That the clause stand part of the Bill.

Andrew Murrison: The clause is not particularly controversial. However, I am drawn to subsection 3(d), which refers to ''relevant disciplinary proceedings'' in relation to disclosure of information. I am not sure what that means. Does it mean what one would understand as professional disciplinary proceedings, or does it mean internal disciplinary proceedings related, for example, to some managerial function? Also, at what level are we talking? Is it relatively trivial disciplinary proceedings, or matters that are more serious?
Disciplinary issues may range from relatively low-key stuff, such as stealing a paper clip, to far more heinous crimes of the sort that the Minister described in trying to tell us how much fraud goes on in the NHS. That is obviously big-ticket stuff, so we need to know what is really meant by ''relevant disciplinary proceedings''. In particular, some clarification of the word ''relevant'' would be useful.

Jane Kennedy: The hon. Gentleman needs to remember the context within which we expect these powers to be used, because use of the powers will be supervised by senior staff. He may wish to know that  the Counter Fraud and Security Management Service already considers the full range of available sanctions as an investigation into a suspicion of fraud, a security incident or a breach commences and as it proceeds. Its objective in approaching the investigation would be to consider the full range of sanctions available to it in the event that the fraud is proven. Disciplinary proceedings clearly fit into that. The bodies referred to could include professional disciplinary proceedings, the General Medical Council, the General Dental Council and others.
Therefore, the hon. Gentleman is right to think that the full range would be considered. However, it is hard to imagine the counter fraud service using such powers in the event of a relatively small case such as the theft of a paper clip. I realise that he used that to illustrate the range, but I seek to reassure him that the expertise and professional approach that the service adopts in bringing cases will inform the nature, scope and range of the documents that it seeks to access and the amount of information available. The information required to be disclosed will only be that which is absolutely relevant and necessary for the case of fraud to be proven. 
Question put and agreed to 
Clause 47 ordered to stand part of the Bill.

Clause 48 - Special protection for personal records

Question proposed, That the clause stand part of the Bill.

Andrew Murrison: The title of the clause is ''Special protection for personal records''. My understanding is that patient identifiable records would be disclosed only on receipt of a court order. I seek the Minister's assurance that that is correct. I think that she gave such an assurance in her initial remarks. The purpose in my discussing the clause briefly is to seek her confirmation that she shares that understanding of the matter.

Jane Kennedy: It is useful to have the opportunity to clarify things. This is so important that it bears repetition—just the once, hon. Members will be pleased to learn. There may be circumstances in which information from personal records obtained under these powers will enable a person to be identified either from that piece of information or if it is combined with other information. In such cases, I acknowledge that special care has to be taken.
Where the information is disclosed for the purposes of any court or disciplinary proceedings, the person disclosing it must take steps to ensure that unless there is a court order the information is not disclosed to any member of the public. However, a party to legal proceedings may apply to the court for the information to be used as evidence in a case. Such a party would have to apply to the court and it would be a decision for the court. The court may agree to this, but to safeguard the identity of the individual, because there is the risk of identification, it may require all or some of the proceedings of that court case to be held in  private. I hope that that gives the hon. Gentleman a bit more clarity on the point.

Andrew Lansley: To be sure about things, may I inquire about two points. The first relates to the inclusion of the words a ''member of the public''. Surely the point is not so much that information should not be disclosed to any member of the public but, from an individual's point of view, that it should not be disclosed to any person for whom it is not essential to the court proceedings. I am unsure what a ''member of the public'' means in this context. Does it mean anyone who is not related to the court proceedings in any way, including NHS staff for example?
I may have missed the answer to my second point, but this seems to be the appropriate point at which to ask the question. Where information from somebody's personal records is produced in connection with such a case, where are the obligations on the counter-fraud service to ensure that it is aware of that? Will it be unaware of that or will there be some provision to ensure that it is aware that the information is being used, and aware of to whom it is being disclosed and for what purposes?

Jane Kennedy: The hon. Gentleman asks me to define more clearly what we mean by ''the public''. I want to reflect on the points that have been made because I want things to be right. We mean those not engaged in the case. The information will be anonymised, as I was describing earlier. I am unsure whether he was present then. The information will be anonymised and only that which is absolutely relevant and necessary for the case to be demonstrated will be disclosed.
We are creating a criminal offence of misuse of the information, so that when the officers of the counter-fraud service have the information, there will be a heavy duty on them to ensure that it is dealt with properly and only disclosed appropriately. We are concerned with giving special protection for those who might be identified even if the information is anonymised. We are saying to those involved in prosecuting and hearing cases that they have a duty on disclosure, even if we are talking about anonymous information put together with other information. We think of somebody not directly involved with the case—a court reporter or a journalist in particular—but the provision refers to any member of the public. It is right that we should give the utmost, stringent protection possible in relation to the information. If it is possible that someone will be identified, that is the responsibility of those managing and hearing the case. The court will be invited to consider the circumstances in which the evidence should be presented, with the concerns that the hon. Gentleman has just raised specifically in mind. I hope that that answer gives him the reassurance he seeks. I will reflect on the points raised in order to reassure myself that we have got this absolutely right. I think that we have, but I will consider those points to be absolutely sure. 
Question put and agreed to. 
Clause 48 ordered to stand part of the Bill. 
Clause 49 ordered to stand part of the Bill.

Clause 50 - Offences relating to disclosure or use of information

Question proposed, That the clause stand part of the Bill.

Andrew Lansley: I did not have the opportunity to ask this earlier, but I am keen that we should, in each case, ask about the basis for decisions about the level of penalties associated with particular offences under the legislation. Will the Minister explain the choice of penalties used here and whether that decision relates directly to any previous precedent?

Jane Kennedy: I am grateful to the hon. Gentleman for asking that question, because I asked the same question. I know that the offences of and penalties for failing to produce documents and wrongful disclosure have been reviewed and approved by the Home Office. Comparable powers to require the production of documents are held by the Audit Commission, Healthcare Commission and Government Departments such as the Department for Work and Pensions, and the respective penalties are broadly comparable, so we think that we have got the balance about right. They are all appropriate for the circumstances to which they apply. The penalties for wrongful disclosure in Healthcare Commission and Audit Commission legislation are broadly similar, and the maximum penalty is the same. I am sure that that is the absolute response that the hon. Gentleman seeks.
Question put and agreed to. 
Clause 50 ordered to stand part of the Bill. 
Clause 51 ordered to stand part of the Bill.

Clause 52 - Interpretation

Question proposed, That the clause stand part of the Bill.

Andrew Lansley: I am sorry, but I have a quick question, which I might have asked earlier, regarding subsection (5). I want to ask about the nature of the special health authorities and to whom the functions are likely to be delegated. The provision further defines who within those special health authorities are the appropriate officers to exercise those functions—this is particularly to do with disclosure and the execution of notices to produce documents and the like. Are we talking about the Healthcare Commission alone or a range of authorities? Perhaps we could have some sense of who they are.

Jane Kennedy: I sought to say this in my opening comments. The only officers who will be able to discharge those powers will be officers of the Counter Fraud and Security Management Service, which is a special health authority at the moment, but which will merge with other organisations in the Business Services Authority, but only officers of the CFSMS within the BSA of the NHS will have those powers. As I sought to reassure the Committee earlier, they are highly trained individuals and the use of the powers will be supervised by senior officers in the service. I  hope that I have reassured the hon. Gentleman that we take seriously the concerns that he and the hon. Member for Westbury raised this afternoon. I, too, want to be sure that we are taking forward and awarding powers that are appropriate to the nature of the problem, and I hope that I have demonstrated that this afternoon.
Question put and agreed to. 
Clause 52 ordered to stand part of the Bill.

Clause 54 - The Appointments Commission

Question proposed, That the clause stand part of the Bill.

Andrew Lansley: I do not want to engage in a long discussion about the Appointments Commission. I understand, to a limited extent, what is intended, and I welcome it. It should establish greater independence as to appointments across many NHS functions. However, I want to be sure, as we begin consideration of the next few clauses, about the nature of the process that the Government are entering into.
In particular, I am looking for a sense of the basis on which the Government will appoint the Appointments Commission, as it were—what sort of criteria they are looking for, and when and how they propose to go about the task. There is also the matter of foundation trusts, but that is in a separate clause and it might be simpler to leave it until later. At present I am really interested in the process of transfer between the NHS Appointments Commission and the new Appointments Commission, as well as the opportunities that that will give Ministers for recasting the membership of the Appointments Commission, or alternatively the extent to which the existing NHS Appointments Commission structure may continue into the new body.

Caroline Flint: This and the other clauses are relatively uncontroversial, but in some ways they reflect the current workings of the NHS Appointments Commission. Hon. Members may be aware that in its 2003 report the Public Administration Committee said that other Government Departments could benefit from its skills and expertise. Therefore, the clause establishes a new body, the Appointments Commission, as an executive non-departmental public body and abolishes the NHS Appointments Commission, which the new body will replace.
The Secretary of State will appoint the chairman and non-executive members of the board. The chief executive and executive members will be appointed by the chairman and non-executive members. The members themselves will appoint a vice-chairman. At least one, but not more than four, of the non-executive members must be appointed to the health and social care appointments committee. I shall write to the hon. Gentleman in more detail about the different transitional arrangements, if that will help. 
Obviously, the appointments by the Secretary of State must be made in a transparent and open way that is fully in line with appointments by Secretaries of  State in other Departments. However, the setting up of the new body provides scope for other organisations across Whitehall, but also the foundation trusts, to which we shall come later, to use its services. I hope that that reassures the hon. Gentleman. I shall write to him in more detail about transitional arrangements.

Schedule 4 - The Appointments Commission: Supplementary

Amendment made: No. 77, in schedule 4, page 73, line 40, leave out 'a copy' and insert 
'copies of the accounts and'.—[Caroline Flint.] 
Schedule 4, as amended, agreed to. 
Clause 55 ordered to stand part of the Bill. 
Schedule 5 agreed to. 
Clause 56 ordered to stand part of the Bill.

Clause 57 - Commission to exercise Privy Council's appointment functions

Question proposed, That the clause stand part of the Bill.

Andrew Lansley: I just want to ask whether the bodies to which the appointment function particularly refers, which are those listed in schedule 6, have made any representations in relation to the transfer of the appointment functions to an Appointments Commission. I must confess that from my recollection of such matters in the Cabinet Office, the Privy Council appointments process is not necessarily one to which I would wish to have myself subjected as one of the bodies. However, they might have an attachment to it born of a sense of the independence of the Privy Council office as distinct from governmental appointments. I would be surprised if they had any objections, but it would be useful to know whether there were any objections to the transfer of the long-standing arrangement.

Caroline Flint: To clarify the situation for the hon. Gentleman, the Privy Council has powers to direct the NHS Appointments Commission to exercise all or part of its functions relating to specified appointments to the health profession's regulatory bodies. In directions of 10 February 2005, the Privy Council directed the NHS Appointments Commission to exercise all its appointment functions relating to the General Chiropractic Council, the General Osteopathic Council, the Health Professions Council, and the Nursing and Midwifery Council. The directions also specified particular appointment functions for the General Medical Council, the General Dental Council, the General Optical Council and the Royal Pharmaceutical Society of Great Britain. The clause gives the Privy Council the same powers to direct the new appointments commission to exercise all or part of the powers that it previously directed the NHS Appointments Commission to provide for. I am not aware of any concerns from any of the bodies that I have mentioned about that function being carried out.  If I am wrong about that, I will ask my officials to check and will get back to the hon. Gentleman.
Question put and agreed to. 
Clause 57 ordered to stand part of the Bill. 
Schedule 6 agreed to. 
Clauses 58 and 59 ordered to stand part of the Bill.

Clause 60 - Commission to assist other bodies with appointments

Question proposed, That the clause stand part of the Bill.

Andrew Lansley: I am quite interested in this matter, not least because Papworth hospital foundation trust is in the throes of appointing a new chairman. In discussion about the process, I was interested to learn that the trust was not in a position to use the NHS Appointments Commission as a structure to assist it. From that point of view, it would have been helpful if the provision had already been in place to allow that to happen. I do not know what is available on an informal basis to help.
Can I take it that in the not-distant future hospitals across the country will be able to use the commission in the appointment of chairmen and other non-executive directors, although they will be under no obligation to do so? If they use the commission, will they be able to do so on the basis that it will be able to undertake such advisory and other arrangements as they determine? Will it have to delegate the functions or will it be simply advisory? If they use the commission, how will the financing work? We have just approved the schedule that allows the commission to be funded by the Government. Does that extend to the commission being able to undertake advisory activities and support the appointments of foundation trusts in a way that is subsidised from the support to the commission, or will such activities be rechargeable back to foundation trusts? 
I take it that the fact that foundation trusts can use the commission does not mean that they will be required to do so. Can we have it on the record that the boards of governors of foundation trusts will have the discretion whether or not to use the commission to make such appointments?

Stephen Williams: The title of the clause is ''Commission to assist other bodies with appointments'', and something occurred to me while we were cantering through. We all subscribe, I am sure, to patient involvement in the NHS. I regularly receive from various bodies the minutes of the two patients forums that scrutinise the work of the two primary care trusts that cover my constituency as well as the two acute trusts. Often those meetings discuss important matters and are seen as valid consultation of the community, but they are sometimes thinly attended. Clearly, the chair of the organisation is a lay person and has important role in the community. It is not clear how such chairs are selected or screened. Is it envisaged that the new NHS Appointments Commission will have a role in making sure that the chairs of the various patients forums that undertake  such important work have gone through a process? Perhaps the Minister will write to me. Will the patients forums receive advice to make sure that they recruit their chairs openly so that anyone from the community can apply and take part?

Caroline Flint: I hope that I can clarify the position. Under clause 60, the commission can in future enter into arrangements, contractual or otherwise, to provide boards of governors of foundation trusts with such assistance or support as they may request when appointing chairmen and non-executive directors. The board of governors of the foundation trusts will continue to make the appointment. Such matters have arisen from recent discussions when, for example, the NHS Appointments Commission has sometimes been asked to provide recruitment and other advice not only to organisations such as Monitor but to Government Departments. The facility will give powers to the commission to provide such services, but it will be up to the foundation trust to decide whether it wants an assessment of the services that it provides.
The facility will be on a cost-recovery basis, so the foundation trust, for example, would be charged. However, providing the service will be non-profit making.

Andrew Lansley: I wish to satisfy my curiosity. The Minister will recall that, under the 2003 legislation, there are circumstances in which Monitor, the independent regulator of foundation trusts, can step in and replace executive directors. If I recall correctly, other members of the board of directors of a foundation trust may be chairmen or non-executive directors. If Monitor steps in, is it required to use the commission or could it exercise the powers of the board of governors under its special measures regime?

Caroline Flint: I understand that it is not a requirement for Monitor to use the NHS Appointments Commission, but it can seek its support and advice. Clearly, in its own right it has its own rules and responsibilities as a regulator for NHS foundation trusts and powers to enable it to carry out such work.
I shall write to the hon. Gentleman about the governance of boards of foundation trusts rather than prolong this afternoon's proceedings.

Stephen Williams: Patients forums.

Caroline Flint: Sorry; patients forums. I shall check Hansard to make sure that the hon. Gentleman receives the accurate information that he requested.
Question put and agreed to. 
Clause 60 ordered to stand part of the Bill. 
Clauses 61 to 66 ordered to stand part of the Bill. 
Schedule 7 agreed to. 
Clauses 67 to 69 ordered to stand part of the Bill.

Clause 70 - NHS costs recovery

Question proposed, That the clause stand part of the Bill.

Andrew Lansley: We have shifted to a different subject. The Minister will no doubt have text that explains the clause better than I can. I recall the discussion that we had on the 2003 legislation about the extension of NHS costs recovery, which has not been brought into effect. If I remember correctly, the previous provision, which was for the recovery of costs when road traffic accidents gave rise to NHS treatment and there was an insurance policy in place that enabled a liability to be met by the insurers, was to be extended in the 2003 legislation to personal injury claims. In effect, it was likely to apply mainly to occupational health-related claims and the like.
My memory is that the Government legislated for that cost recovery in 2003 and subsequently consulted on the nature of it. In the course of that consultation, problems emerged about the precise circumstances in which costs could be recovered. The explanatory notes help us by stating 
''contributory negligence to be taken into account''.
The previous legislation simply would not have enabled the recovery amount to be varied. 
We expressed concern once about the extent of the liability that was likely to emerge for businesses more than once in the course of the discussion on the 2003 legislation. It has not been my responsibility since, but I am aware that since 2003, and particularly during 2004, there were substantial increases in the cost of employers' compulsory liability insurance. In fact, many insurers found that they were doubling or tripling it. I shall not rehearse the ways in which the Government have tried to respond to that, not least because I do not precisely remember them all. They have intervened since the 2003 legislation through such things as the Office of Fair Trading investigation to determine whether there were any difficulties in the marketplace. Also, the Department for Work and Pensions had a review, the purpose of which was to work with the industry to try to offset the rising costs. 
All of that is slightly by the way. The point is that the Minister with responsibility for small business, who is one of the relevant Ministers in the Department of Trade and Industry—the Minister knows who I mean—made it clear that the Department would not introduce this additional imposition on businesses until such time as the problems associated with the rise in employers' compulsory liability insurance and the cost that that would impose on businesses had been resolved. I believe that it was the hon. Member for Edinburgh, South (Nigel Griffiths), who is now the Deputy Leader of the House of Commons, who said that. I do not think for a minute that those problems have been resolved. 
I know enough about my friends in business representative organisations, whether it be the Federation of Small Businesses or the British Chambers of Commerce—I declare a past and current interest—or others. They would tell us that  employers' compulsory liability insurance continues to rise. The market is much more difficult for businesses than it used to be and, notwithstanding the fact that this part of the Bill will somewhat ameliorate the total extent of the increase in costs that businesses have to bear, we are looking at a substantial further increase in the charges that will have to be met through personal liability insurance. That will have an upward impact on premiums. 
I do not have the regulatory impact assessment in front of me, but I am sure it will say that that is not a problem because the Bill reduces the amount that is recovered overall from businesses. However, it is a problem, because we have been holding off—I say ''we'' advisedly. The Government have held off introducing this additional cost recovery scheme because of the problems that business is experiencing. I want to know why they are not continuing to do that. It is clear from what the Minister said that they propose to introduce the measure in 2006. She might be able to confirm the date, but I thought that it was fairly soon. I reiterate our concern that it should not be introduced, with the resulting additional increase in premiums, unless and until the problems in the business sector about access and the cost of employers' compulsory liability insurance have been resolved.

Caroline Flint: In relation to the hon. Gentleman's detailed points, and the comments that he ascribed to one of my ministerial colleagues, I will seek guidance on the issue and on its relevance and impact—

Andrew Lansley: To avoid uncertainty, may I say that the Minister of State, Department of Health, the hon. Member for Doncaster, Central may even have said herself that she would not introduce the proposal until these matters had been resolved in consultation with the Department for Trade and Industry.

Caroline Flint: I will seek to verify the situation in that respect. In relation to the clause, it was proposed because, following the 2003 Act there was still considerable discussion and consultation about whether it provided adequately for contributory negligence to be taken into account in a wider range of cases, which did not just involve court processes.
The proposal will retain option A of section 153 of the 2003 Act, but will expand option B so that any form of non-court based negotiated settlement, which has formal recognition of contributory negligence, can qualify for a similar reduction in independent complaints reviewer charges, not just mediation. For example, arbitration or a settlement negotiated by solicitors or insurers without recourse to the courts, or even just agreed between the parties themselves rather than their representatives, will be acceptable. That is important because I understand that more than 90 per cent. of personal injury claims are resolved without going to court. The proposal will greatly increase the number of cases in which contributory negligence can be taken into account. The hon. Gentleman took the words out of my mouth. 
Contributory negligence recognises that the individuals themselves played a part in the injury  that they sustained and thus should be welcomed by business interests since it would, I hope, logically result in compensators having to pay less in NHS charges in many more cases in which contributory negligence is accepted as a factor in the primary compensation claim. 
As I said, I will verify the other issues that the hon. Gentleman raised. Rather than re-open the 2003 discussions, which led to the Act, the proposals tackle areas that should have been tackled earlier. 
Question put and agreed to. 
Clause 70 ordered to stand part of the Bill.

Clause 71 - Transfer of criminal liabilities of certain

Andrew Murrison: I beg to move amendment No. 23, in clause 71, page 54, line 17, leave out 'which may be' and insert 'that will be'.

Eric Illsley: With this it will be convenient to discuss the following amendments:
No. 24, in clause 71, page 54, line 28, leave out 'which may be' and insert 'that will be'. 
No. 25, in clause 71, page 55, line 2, leave out 'which may be' and insert 'that will be'. 
No. 26, in clause 71, page 55, line 9, leave out 'which may be' and insert 'that will be'. 
No. 27, in clause 71, page 55, line 14, leave out 'which may be' and insert 'that will be'. 
No. 28, in clause 71, page 55, line 19, leave out 'which may be' and insert 'that will be'.

Andrew Murrison: We now enter the final furlong of the Committee stage. The clause is particularly welcome; the amendments simply beef up the wording, which places obligations on organisations to have their liabilities transferred. The wording seems to me to be permissive rather than obligatory. The amendments would beef up the wording so that the liabilities were transferred.
We are discussing criminal liabilities in the context of NHS bodies, but it is worth pointing out that the Government establish, disestablish and merge NHS bodies at a phenomenal rate and it is particularly welcome that they should ensure that when they do so, the bodies' liabilities are transferred to successor organisations. 
Many of us who have witnessed the demise of various health authorities in the past few years will bear witness to the fact that once the bodies are dissolved, their sins of omission and commission often dissolve with them. I have had a five-year quest to find out why certain things have gone wrong with my own local health care economy. The common factor appears to be a health authority that has long since dissolved and the persons associated with it dispersed. To be perfectly honest, trying to pin anything on the authority is a bit like trying to nail jelly to the wall. Any measure that helps us to transfer liabilities of any sort from one NHS body to another is to be warmly  welcomed. The case in question is clearly a criminal matter. 
It would be nice to hear the Minister say that liabilities in general should be properly transferred when bodies disestablish, merge or close down. Given the rate at which such bodies appear to be doing just that, it is important to retain the audit trail so that we can attribute things when they go wrong. That goes for bodies and, in the context of proper management, individuals. Since I have been a Member of Parliament, dealing with my local health care economy has been a source of great frustration. I welcome the clause to the extent that it helps us attribute things properly. I hope that in that spirit, the Minister will accept our amendments.

Caroline Flint: The need for clause 71 arose following a Court of Appeal ruling in the case of R v. The Pennine Acute Hospitals NHS Trust, formerly Rochdale Health Care NHS Trust. In that case, the Court held that the general power in paragraph 30 of schedule 2 to the NHS and Community Care Act 1990 to transfer property rights and liabilities on the dissolution of an NHS trust did not include the power to transfer criminal liabilities. The Court stated that if it was the intention to transfer criminal liability, the legislation should explicitly say so.
There were clearly issues surrounding the perception that the powers transferred criminal liabilities. In a test case the judge decided that they did not, and that is why we have brought forward this clause. I have had discussions with officials about its wording, and when we were considering the issue and addressing the problem highlighted by the Court of Appeal, we thought that it might be necessary to provide a power to transfer criminal liabilities only for those NHS bodies that deliver front-line services—those bodies that could realistically face criminal prosecution in connection with the front-line services that they deliver to patients. 
In the case of a strategic health authority, for example, it was difficult to envisage a case in which it might face criminal proceedings about patient care. However, as our thinking developed, we thought that it might be necessary to transfer the criminal liabilities of a front-line body to a strategic health authority when there was no logical or obvious successor to which the powers could be transferred. It means that in the course of natural justice for individuals, any such liabilities that might be transferred to a strategic health authority are similarly transferred onwards in case of its own abolition or dissolution, thereby ensuring that the liabilities are always retained in the NHS. 
If the Committee has managed to follow me, it would not normally be necessary to transfer a strategic health authority's criminal liabilities on its abolition, hence it is right to make the provision a power rather than a duty. When an SHA has inherited criminal liabilities from another NHS body delivering front-line services, the power can be used to transfer them onwards in the event of the SHA's abolition. 
It has always been the Department's intention to transfer the criminal liabilities of NHS bodies on their abolition or dissolution, because we want to ensure that public accountability for any criminal offence is retained in the NHS. I hope that the hon. Member for Westbury agrees that the very fact that we have brought forward the clause shows our intention to transfer such liabilities. That is the Department's intention. 
The second reason why the provision should be framed as a power rather than a duty is that it falls in line with various pieces of health legislation that provide the Secretary of State or the National Assembly for Wales with a power to transfer the property rights and liabilities of an NHS body to another NHS body on the former's dissolution or abolition. 
The slightly unusual nature of the liability in question means that it is sensible to have a power rather than a duty. The Court of Appeal made it clear in its ruling that criminal liabilities were somewhat different in nature to other, general liabilities. However, I think that we are all agreed that we certainly do not want to create a situation in which people who are the victims of criminal offences lose out on justice just because an organisation is dissolved or reorganised into a different body.

Andrew Murrison: I thank the Minister for that. Of course, I accept that criminal liabilities are very different from general liabilities. I have no doubt that that is the case. I accept the explanation that she has given and I hope that she will accept my more general point about the transfer of general liabilities, because it is important. With her reassurance, I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn. 
Clause 71 ordered to stand part of the Bill.

New Clause 8 - Amendments relating to Local Health Boards and abolition of Welsh health authorities

(a) in order to reflect the fact that (by virtue of relevant directions) transferred functions may be exercised by Local Health Boards, or 
(b) otherwise in consequence of, or in connection with, the abolition of Welsh health authorities effected under section 27(5) of the Government of Wales Act 1998 (c.38). 
(2) Where a transferred function which became exercisable by a Local Health Board by virtue of relevant directions ceases to be so exercisable, the Secretary of State or the Assembly may by order— 
(a) substitute for any reference to a Local Health Board in any enactment relating to the function a reference to the Assembly, and 
(b) make such amendments of any enactment as he or it considers appropriate in consequence of any such substitution. 
(3) No order may be made under subsection (1)(a) in relation to a transferred function on or after the date on which subsection (4) applies to the function. 
(4) This subsection applies to a transferred function on the date when either of the following comes into force in relation to the function— 
(a) an order made under subsection (1)(b) which amends an enactment so as to provide for the function to be exercisable only by the Assembly, or 
(b) an order made under subsection (2). 
(5) In this section— 
''amendments'' includes repeals, revocations and modifications; 
''the Assembly'' means the National Assembly for Wales; 
''relevant directions'' means directions given in regulations made under section 16BB of the National Health Service Act 1977 (c.49); 
''transferred function'' means a function transferred to the Assembly by the Health Authorities (Transfer of Functions, Staff, Property, Rights and Liabilities and Abolition) (Wales) Order 2003 (S.I. 2003/813 (W. 98)); 
''Welsh health authority'' means a Health Authority for an area in, or consisting of, Wales.'.—[Caroline Flint.]
Brought up, and read the First time.

Caroline Flint: I beg to move, That the clause be read a Second time formally.

Eric Illsley: With this it will be convenient to discuss Government amendments Nos. 138 to 140.

Andrew Murrison: I am slightly surprised that the Minister did not speak to the new clause because these are Government changes and I thought that the Minister might like to explain why she is introducing them at this stage. I would have liked her to do so.

Caroline Flint: New clause 8 and related minor amendments Nos. 138, 139 and 140 allow the Secretary of State or the National Assembly for Wales to make orders by statutory instrument to deal with out-of-date references to health authorities in legislation. Since the establishment of PCTs in England and local health boards in Wales, there are no longer any health service bodies called health authorities. The order-making power will enable statutory references to be updated. Such an order could be used to reflect the fact that, since the abolition of health authorities in Wales, most of their former functions have been delegated to local health boards. If the Assembly were to decide to withdraw that delegation in future, the order could substitute a reference to the Assembly in place of a reference to a local health board. These are technical changes to update the language used.

Andrew Lansley: Did the Government consider using the Government of Wales Bill for that purpose, rather than this Bill? It seems slightly odd to bring the matter forward at this stage when there is another legislative vehicle available.

Caroline Flint: Section 27 of the Government of Wales Act 1998, contained an order-making power that enabled the National Assembly for Wales to make consequential amendments to legislation when health authorities were abolished in Wales. The power was not used when that occurred, and I am advised that it can no longer be used: it is spent. I hope that that adequately answers the hon. Gentleman's question.

Andrew Lansley: It only reinforces the question. Since there is a Government of Wales Bill being considered on the Floor of the House and Government of Wales legislation previously seems to have been appropriate for this purpose, it seems that it would have been more appropriate to use that legislative vehicle, thereby giving greater notice of the measure, rather than introducing it in the Committee on this Bill.

Caroline Flint: The opportunity was taken to deal  with the matter in the Health Bill. As I say, it is technical matter and just refers to changing the terminology relating to health boards. We need to do that now in the context of the consolidation Bills currently being prepared.
Question put and agreed to. 
Clause read a Second time, and added to the Bill.

Clause 53 - Accounts and Audit

Question proposed, That the clause stand part of the Bill.

Andrew Lansley: I have one question. I understand that NHS bodies can establish non-charitable trusts to hold property assets. However, paragraph 11 of schedule 8 makes it clear that they are not to be included in summarised accounts. It is not inconceivable that the property assets of non-charitable trusts of NHS bodies could in future have such a volume of assets that it would be necessary to understand the overall balance sheet position of an NHS trust.
It being Seven o'clock, The Chairman proceeded, pursuant to Standing Order 83D and the Order of the Committee [6 December] to put forthwith the Question already proposed from the Chair. 
Question put and agreed to. 
Clause 53 ordered to stand part of the Bill. 
The Chairman then proceeded to put forthwith the Questions necessary to dispose of the business to be concluded at that time.

Schedule 3 - New Schedule 12B to 1977 Act

Amendments made: No. 125, in schedule 3, page 65, line 39, leave out paragraph 3 and insert— 
'3 (1) Each English NHS body or cross-border SHA must keep proper accounts and proper records in relation to the accounts. 
(2) If the Secretary of State so directs with the approval of the Treasury, the accounts of any such body of a description specified in the direction must be kept in such form as is so specified. 
(3) Each Welsh NHS body must keep proper accounts and proper records in relation to the accounts. 
(4) If the Assembly so directs with the approval of the Treasury, the accounts of any such body of a description specified in the direction must be kept in such form as is so specified. 
(5) This paragraph has effect subject to the exception in paragraph 10(2).'. 
No. 126, in schedule 3, page 66, line 5, leave out paragraph 4. 
No. 127, in schedule 3, page 66, line 24, at end insert— 
'Auditing of accounts of certain English NHS bodies 
5A (1) This paragraph applies to any English NHS body that is not a Special Health Authority (as to which, see paragraph 7). 
(2) Any annual accounts prepared by any such body under paragraph 5 are to be audited in accordance with the Audit Commission Act 1998 (c.18) by an auditor or auditors appointed by the Audit Commission (see section 2(1)(b) of that Act). 
(3) The Comptroller and Auditor General may examine— 
(a) any such accounts and any records relating to them, and 
(b) any report on them by the auditor or auditors. 
(4) In this paragraph ''the Audit Commission'' means the Audit Commission for Local Authorities and the National Health Service in England and Wales.'. 
No. 128, in schedule 3, page 66, leave out lines 26 to 36 and insert— 
'(1) Each English NHS body to which paragraph 5A applies must send a copy of any accounts of the body audited as mentioned in paragraph 5A(2) to the Secretary of State by the specified date. 
(2) If the body is a Primary Care Trust, it must also send a copy of any such accounts to the Strategic Health Authority within whose area the Trust's area falls. 
(3) Each Special Health Authority that is an English NHS body or cross-border SHA must send copies of any annual accounts prepared by it under paragraph 5— 
(a) to the Secretary of State by the specified date, and 
(b) to the Comptroller and Auditor General as soon as is reasonably practicable following the end of the financial year in question. 
(4) In sub-paragraph (1) or (3) ''the specified date'', in relation to a financial year, means such date as the Secretary of State may direct in relation to that year for the purposes of that sub-paragraph.'. 
No. 129, in schedule 3, page 68, line 8, leave out 'or 4'.—[Caroline Flint.] 
Schedule 3, as amended, agreed to. 
Clauses 72 to 74 ordered to stand part of the Bill.

Clause 75 - Orders and regulations

Amendments made: No. 138, in clause 75, page 57, line 29, after 'section', insert 
'(Amendments relating to Local Health Boards and abolition of Welsh health authorities) or'. 
No. 83, in clause 75, page 57, line 37, at end insert— 
'( ) No statutory instrument containing an order under section 76(3A) which amends or repeals any provision of an Act or an Act of the Scottish Parliament may be made by the Scottish Ministers unless a draft of the instrument has been laid before, and approved by a resolution of, the Scottish Parliament. 
( ) Otherwise, a statutory instrument containing an order under section 76(3A) is to be subject to annulment in pursuance of a resolution of the Scottish Parliament.'.—[Caroline Flint.] 
Clause 75, as amended, ordered to stand part of the Bill.

Clause 76 - Amendments, repeals and revocations

Amendments made: No. 84, in clause 76, page 58, line 10, at end insert— 
'(3A) The Scottish Ministers may by order make— 
(a) such supplementary, incidental or consequential provision, or 
(b) such transitory, transitional or saving provision, 
as they consider appropriate for the general purposes, or any particular purposes, of the provisions specified in subsection (3B) or in consequence of, or for giving full effect to, any of those provisions. 
(3B) Those provisions are— 
(a) section 33(2), 
(b) so far as extending to Scotland, section 70 and paragraph 53 of Schedule 8. 
(3C) An order under subsection (3A) may not include any provision which would be outside the legislative competence of the Scottish Parliament if it were included in an Act of that Parliament. 
(3D) An order under subsection (3) may not include any provision which it would be competent for the Scottish Ministers to make in an order under subsection (3A).'. 
No. 85, in clause 76, page 58, line 11, after '(3)' insert 'or (3A)'.—[Caroline Flint.] 
Clause 76, as amended, ordered to stand part of the Bill.

Schedule 8 - Minor and consequential amendments

Amendments made: No. 130, in schedule 8, page 80, line 30, leave out 
'prepared in accordance with directions under'. 
No. 131, in schedule 8, page 80, line 31, leave out 
'kept in accordance with directions under paragraph 3(1)' 
and insert 'paragraph 5(1)'. 
No. 132, in schedule 8, page 81, line 1, leave out sub-paragraph (2) and insert— 
'(2) Omit paragraph 1(g).'. 
No. 133, in schedule 8, page 81, leave out lines 4 to 6 and insert— 
''1A Section 2 also applies to annual accounts of health service bodies prepared under paragraph 5(1) of Schedule 12B to the National Health Service Act 1977.''.'.
No. 134, in schedule 8, page 81, line 10, before 'section', insert 
'the accounts kept in pursuance of'. 
No. 135, in schedule 8, page 81, line 11, leave out 'paragraph 3(2)' and insert 
'any accounts kept or prepared in pursuance of paragraph 3 or 5'. 
No. 136, in schedule 8, page 81, line 13, after 'accounts' insert 'or prepare annual accounts'.—[Caroline Flint.] 
Schedule 8, as amended, agreed to.

Schedule 9 - Repeals and revocations

Amendment made: No. 137, in schedule 9, page 84, line 33, column 2, leave out 'paragraph' and insert 'paragraphs 1(g) and'.—[Caroline Flint.] 
Schedule 9, as amended, agreed to. 
Clauses 77 and 78 ordered to stand part of the Bill.

Clause 79 - Commencement

Amendments made: No. 139, in clause 79, page 59, line 4, leave out 'section 71' and insert 
'sections 71 and (Amendments relating to Local Health Boards and abolition of Welsh health authorities)'. 
No. 86, in clause 79, page 59, line 5, leave out first 'and' and insert 'to'. 
No. 87, in clause 79, page 59, line 7, at end insert— 
'( ) The following provisions come into force on such day as the Scottish Ministers may by order appoint— 
(a) section 33(2), and 
(b) so far as extending to Scotland— 
(i) section 70, 
(ii) paragraph 53 of Schedule 8, and 
(iii) section 76(1) so far as relating to that paragraph.'.—[Caroline Flint.] 
Clause 79, as amended, ordered to stand part of the Bill.

Clause 80 - Short title and extent etc.

Amendments made: No. 140, in clause 80, page 60, line 5, after 'sections', insert 
'(Amendments relating to Local Health Boards and abolition of Welsh health authorities),'. 
No. 88, in clause 80, page 60, line 6, leave out from 'Act' to 'has' in line 7. 
No. 89, in clause 80, page 60, line 9, leave out subsection (5).—[Caroline Flint.] 
Clause 80, as amended, ordered to stand part of the Bill.

Andrew Lansley: On a point of order, Mr. Illsley. May I express our appreciation to you and your fellow Chairmen for the manner in which you have conducted our proceedings? We on the Opposition Benches appreciate the manner in which the Committee has discussed the Bill's provisions—it seems to have been more for elucidation than for argument's sake. We have exposed a range of important issues. In fact, we discussed nearly all the issues in the Bill—about 10 of them—and although one or two may have had greater prominence, I hope that they all will make a contribution to the management of the NHS—and more particularly to the health of the people of this country.
We appreciate the support from which we occasionally benefited that the Minister received from parliamentary counsel and departmental officials. Once again, all members of the Committee are very much in debt to the Clerks, and to the attendants and the police who look after us. 
Personally speaking, I should like to express my appreciation to my hon. Friend the Member for Westbury (Dr. Murrison). I may have come and gone from time to time, but I value his work immensely; whenever I have heard it, I appreciated his heavy lifting on the Bill. I say thank you to him, and I conclude my point of order on that note.

Stephen Williams: Further to that point of order, Mr. Illsley. I also thank you for your friendly chairmanship of the Committee and particularly for your liberal attitude to dress code. I wish that gentlemen did not have to wear their jackets at all times in other parts of the House of Commons.
We have had 12 sittings. The smoking part of the Bill occupied us and perhaps involved our most lively discussions, and we shall look for further changes when the Bill comes back to the Floor of the House. None the less, the infection control issue and other aspects of the Bill turned out to be more interesting than I had expected; I have certainly learned a lot in my new role as I have helped the passage of the Bill. 
This is the second Standing Committee on which I have served. As I have mentioned a couple of times, my professional background before I came here was in  tax, so the Liberal Democrat Whips put me on the Finance (No. 2) Bill Committee within two weeks of my arrival at the House of Commons. That was certainly a baptism of fire. However, despite my former profession and my interest in tax, this Committee was much more interesting. Perhaps that will not surprise those who have had or will have the joy of sitting on Finance Bills. 
When there have been lapses in concentration—not necessarily during the heavy lifting by the hon. Member for Westbury; maybe at other times as well—I noticed that some Committee members were able to address copious amounts of Christmas cards. One managed to address an entire suitcase-full. Some did crosswords and Sudoku. 
Appropriately, I have chosen to wear my glasses today so that I can take one last look at the fine painting of Gladstone's first Cabinet. That was the subject of my undergraduate dissertation, a copy of which I have had at home for the past 17 years. Every time I go home, I shall now be reminded of my enjoyment of my time on this Committee.

Caroline Flint: Further to that point of order, Mr. Illsley. I thank you, Mr. Caton and Lady Winterton for your services to this Committee. There have been occasions on which the rota has been in disarray and we have had to look for our Chairman—you have always come to the fore, Mr. Illsley.
I thank the Clerks, the attendants and the police officers for their management and support of the proceedings and my own officials from the Department, who have been very supportive on a number of occasions. I also thank my hon. Friends who have acted as Parliamentary Private Secretaries. They have passed me many notes, as and when I have needed them. I also thank my right hon. Friend my fellow Minister for her support. 
In this Committee, I have crossed swords with the hon. Member for Westbury for the first time. I was not in the Room at the time—my right hon. Friend was involved in the proceedings—but I believe that once, when the hon. Gentleman was making a contribution, he turned round to see whether there were any Committee members on his side, only to find that absolutely nobody was there. 
It has been an interesting Committee. One party leader has been anointed, while another—I cannot see any knives in Gladstone's back in the painting mentioned by the hon. Member for Bristol, West—has been given the heave-ho. The Committee has not been without its moments. 
We were working very hard on the last day before the Christmas recess. My right hon. Friend and I tried to bring a bit of flavour to the Committee with our lapel decorations, borrowed, I have to say, from the Christmas tree in the Members' Tea Room—and sent back afterwards. I was disappointed that the flashing Christmas tree badge brought in by my hon. Friend the Member for Lincoln (Gillian Merron) did not work when required to do so. However, I thank her for all she has done to support all Labour Committee members and for making sure that proceedings have run properly. 
We have covered a huge number of areas. We have had some incisive discussions and debates; I have certainly been put on the spot and challenged, as is right. We have gone through the right process to make sure that all areas are given the scrutiny that they deserve. The Bill covers many aspects of health care, each of which is important in its own right, and it will add to the development of health services in England. I thank all members of the Committee for their contributions. 
We learned a lot about individuals. We learned that the hon. Member for Bristol, West is single—I do not know whether he is still single after Christmas—

Stephen Williams: Sadly so.

Caroline Flint: Sadly so, but a Committee always offers an interesting opportunity to get to know hon.  Members just a little better than we sometimes do on the Floor of the House. I thank everybody for that.

Eric Illsley: On behalf of my fellow Chairmen, I thank hon. Members for their kind comments. In relation to the comments of the hon. Member for Bristol, West, I did not see anybody signing any Christmas cards. I could well need the optician that the hon. Member for Mid-Bedfordshire visited during today's break.
Let me quickly add my thanks to the Clerk, John Benger, who has done my heavy lifting throughout the Committee, and to his assistant, to the Hansard writers, to the attendants and, of course, to the police for their assistance during the Committee stage of the Bill. 
Bill, as amended, to be reported. 
Committee rose at eleven minutes past Seven o'clock.